Individual
MATTHEW EDWARD FLYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP, ACNP
Contact information
Practice address
971 LAKELAND DR STE 1052, JACKSON, MS 39216-4609
(601) 981-9503
(601) 982-1198
Mailing address
971 LAKELAND DR STE 1052, JACKSON, MS 39216-4609
(601) 981-9503
(601) 982-1198
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
R860587
MS
363LF0000X
Family Nurse Practitioner
R860587
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05156038
—
MS
01
—
7885550
CIGNA
MS
01
—
P00775214
RAILROAD MEDICARE
MS
Enumeration date
06/10/2009
Last updated
10/10/2012
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