Healthcare Provider Details

I. General information

NPI: 1174802169
Provider Name (Legal Business Name): SHANNON FLESHER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 E BROADWAY ST
CUERO TX
77954-2133
US

IV. Provider business mailing address

1908 N LAURENT ST STE 250
VICTORIA TX
77901-5417
US

V. Phone/Fax

Practice location:
  • Phone: 361-275-9133
  • Fax: 210-202-5058
Mailing address:
  • Phone: 361-576-0694
  • Fax: 210-202-5058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP120786
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: