Provider Demographics
NPI:1174802169
Name:FLESHER, SHANNON (FNP-C)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:FLESHER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 BALCONES DR
Mailing Address - Street 2:STE 102
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4270
Mailing Address - Country:US
Mailing Address - Phone:512-323-5362
Mailing Address - Fax:
Practice Address - Street 1:6010 BALCONES DR
Practice Address - Street 2:STE 102
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4270
Practice Address - Country:US
Practice Address - Phone:512-323-5362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX729612363LF0000X
247200000X
TXAP120786363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other