Provider Demographics
NPI:1225673635
Name:FLESHMAN, MARK NICHOLAS
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:NICHOLAS
Last Name:FLESHMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 STATE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-3104
Mailing Address - Country:US
Mailing Address - Phone:606-585-4814
Mailing Address - Fax:
Practice Address - Street 1:5115 S 3RD ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-2601
Practice Address - Country:US
Practice Address - Phone:502-233-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator