Provider Demographics
NPI:1295135929
Name:SHAHAN, NEKISHA LYNN (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:NEKISHA
Middle Name:LYNN
Last Name:SHAHAN
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 61
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:TX
Mailing Address - Zip Code:78358-0061
Mailing Address - Country:US
Mailing Address - Phone:765-225-1685
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 61
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:TX
Practice Address - Zip Code:78358-0061
Practice Address - Country:US
Practice Address - Phone:765-225-1685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1138205163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant