Individual provider Active NPI

Kelly Flynn, APRN, CPNP-AC

  • Pediatric Nurse Practitioner
  • Oklahoma City, OK
National Provider Identifier
1093352411
Registry record updated Feb 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
134932 Issued in OK
Practice address
1200 Childrens Ave
Oklahoma City, OK 73104-4637
Phone
(405) 271-4700
NPI assigned
Dec 4, 2019
Last updated
Feb 2, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X AP143522 TX
Pediatric Nurse Practitioner 363LP0200X 134932 OK Primary

Addresses

Primary practice location

1200 Childrens Ave
Oklahoma City, OK 73104-4637

Mailing address

1200 Childrens Ave
Oklahoma City, OK 73104-4637

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241022004752 OK Practitioner - Nurse Practitioner 0648703132 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
134932OKMDPediatric Nurse Practitioner
AP143522TXMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ou Health Partners, Inc CurrentSince Sep 1, 2024 Accepting new patients
Ou Health Partners, Inc CurrentSince Sep 1, 2024 Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients

Locations

1200 Childrens Ave
Oklahoma City, OK 73104
Phone (405) 271-2429

1200 Childrens Ave
Ste 2E
Oklahoma City, OK 73104
Phone (405) 271-4864

1200 Everett Dr
Oklahoma City, OK 73104
Phone (405) 271-5125

900 NE 10th St
Oklahoma City, OK 73104
Phone (405) 271-2230

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1575417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580601600000",
    "number": "1093352411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 CHILDRENS AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731044637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 CHILDRENS AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731044637",
            "telephone_number": "405-271-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLYNN",
        "first_name": "KELLY",
        "credential": "APRN, CPNP-AC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-04",
        "last_updated": "2020-02-02",
        "certification_date": "2020-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "TX",
            "license": "AP143522",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "OK",
            "license": "134932",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.