Octavia Lynne Flanagan, RN, PHD

Primary specialty

Women's Health Nurse PractitionerTaxonomy code 363LW0102X

License

421379 Issued in NY

Practice address

600 Fitch St Ste 102
Elmira, NY 14905-1634

Phone

(607) 734-6544

Fax

(607) 734-6580

NPI assigned

Dec 2, 2013

Last updated

Nov 24, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Miss Octavia Lynne Blackwelder Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Doctor of Philosophy, Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Arnot Ogden Medical Center

  • General Acute Care Hospital
  • Elmira, NY
  • NPI 1083605661
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1385942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606176000000",
    "number": "1083045074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "571 SAINT JOSEPHS BLVD",
            "address_2": "FL 2",
            "city": "ELMIRA",
            "state": "NY",
            "postal_code": "149013230",
            "telephone_number": "607-271-2050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 FITCH ST STE 102",
            "city": "ELMIRA",
            "state": "NY",
            "postal_code": "149051634",
            "telephone_number": "607-734-6544",
            "fax_number": "607-734-6580"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2151 Century Ln",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376044469",
            "country_code": "US",
            "telephone_number": "423-926-2500",
            "fax_number": "423-926-5999",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FLANAGAN",
        "first_name": "OCTAVIA",
        "middle_name": "LYNNE",
        "credential": "RN, PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-12-02",
        "last_updated": "2020-11-24",
        "certification_date": "2020-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "NY",
            "license": "421379",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q016313",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05623143",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "OCTAVIA",
            "last_name": "BLACKWELDER",
            "middle_name": "LYNNE",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Marcie Louise Fish
• Lindsey Ann Fisher, PT, DPT
• Nikki Anne Fitch, FNP-C
• Halle Fitzgerald
• Ann-Marie Fitzpatrick, ANP-BC
• Laura J Fleming, RD
• Susan Flynn
• Valerie Folnsbee
• Andrew L. Foltz, PSY.D.
• Charles Anthony Fontana, PH.D.

• Women's Health Nurse Practitioner in Elmira, NY
• Providers in Elmira, NY by specialty
• Women's Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.