Basic Information
| Provider Information | |||||||||
| NPI: | 1811036767 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLANAGAN | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 121 CAHILL RD | ||||||||
| Address2: | STE 204 | ||||||||
| City: | BRANSON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 656162036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4173357296 | ||||||||
| FaxNumber: | 4173357588 | ||||||||
| Practice Location | |||||||||
| Address1: | 121 CAHILL RD | ||||||||
| Address2: | STE 204 | ||||||||
| City: | BRANSON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 656162036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4173357296 | ||||||||
| FaxNumber: | 4173357588 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 08/07/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 2002031429 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 201348 | 01 | MO | MO BLUE SHIELD | OTHER | 427276605 | 05 | MO | MEDICAID | 159887758 | 05 | AR | MEDICAID |