MEDICARE: DR. SHANNON KERRY FLOOD NICHOLS DO

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	207VM0101X	Maternal & Fetal Medicine Physician	DR.0067191	CO
2	207VM0101X	Maternal & Fetal Medicine Physician	OP 60410163	WA
3	207V00000X	Obstetrics & Gynecology Physician	414	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912971573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNON KERRY FLOOD NICHOLS DO

Provider Business Mailing Address
First Line	:	6071 E WOODMEN RD STE 440
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-2614
Country	:	US
Telephone Number	:	719-571-4590
Fax Number	:	719-571-4591

Provider Business Practice Location Address
First Line	:	6071 E WOODMEN RD STE 440
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-2614
Country	:	US
Telephone Number	:	719-571-4590
Fax Number	:	719-571-4591

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

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	11/10/2021

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