Individual
TIMOTHY J FLYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
20375 W 151ST ST, SUITE 306, OLATHE, KS 66061-5306
(913) 782-2292
(913) 782-2381
Mailing address
20375 W 151ST ST, SUITE 306, OLATHE, KS 66061-5306
(913) 782-2292
(913) 782-2381
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
45701
KS
367500000X
Certified Registered Nurse Anesthetist
069074
MO
367500000X
Certified Registered Nurse Anesthetist
Primary
54412
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18441011
BCBS OF KANSAS CITY
MO
05
—
200540360A
—
KS
05
—
912861903
—
MO
01
—
P00606532
RR MEDICARE
KS
Enumeration date
08/23/2006
Last updated
03/07/2014
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