Provider Demographics
NPI:1912971573
Name:FLOOD NICHOLS, SHANNON KERRY (DO)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:KERRY
Last Name:FLOOD NICHOLS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6071 E WOODMEN RD STE 440
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-2614
Mailing Address - Country:US
Mailing Address - Phone:719-571-4590
Mailing Address - Fax:719-571-4591
Practice Address - Street 1:6071 E WOODMEN RD STE 440
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2614
Practice Address - Country:US
Practice Address - Phone:719-571-4590
Practice Address - Fax:719-571-4591
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0067191207VM0101X
WAOP 60410163207VM0101X
NE414207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000196236Medicaid