Provider Demographics
NPI:1023347689
Name:FLYNN, AMY COLLEEN (PA)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:COLLEEN
Last Name:FLYNN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W 38TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6400
Mailing Address - Country:US
Mailing Address - Phone:512-324-3580
Mailing Address - Fax:512-324-3583
Practice Address - Street 1:1600 W 38TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6400
Practice Address - Country:US
Practice Address - Phone:512-324-3580
Practice Address - Fax:512-324-3583
Is Sole Proprietor?:No
Enumeration Date:2009-12-10
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TXPA06500363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX212311903Medicaid
TXTXB106341Medicare PIN