Basic Information
| Provider Information | |||||||||
| NPI: | 1942587894 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLESHER | ||||||||
| FirstName: | KRISTA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1112 | ||||||||
| Address2: | |||||||||
| City: | FAIRMONT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 265551112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043678740 | ||||||||
| FaxNumber: | 3043669529 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 COLUMBIA RD | ||||||||
| Address2: | |||||||||
| City: | SHINNSTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 264311016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045921040 | ||||||||
| FaxNumber: | 3045925317 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2011 | ||||||||
| LastUpdateDate: | 04/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 65369 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.