MEDICARE: MS. SHANNON LEIGH FLEMING RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	745190	TX

General Provider Information

NPI Number	:	1750983946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHANNON LEIGH FLEMING RN

Provider Business Mailing Address
First Line	:	4202 SONDRA DR
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-2532
Country	:	US
Telephone Number	:	480-526-0467
Fax Number	:

Provider Business Practice Location Address
First Line	:	4202 SONDRA DR
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-2532
Country	:	US
Telephone Number	:	480-526-0467
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2020
Last Update Date	:	11/12/2020

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