Individual provider Active NPI

Shana Marie Leckliter, FNP

  • Family Nurse Practitioner
  • Fredericksburg, VA
National Provider Identifier
1629808258
Registry record updated Aug 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0024190890 Issued in VA
Practice address
1001 Sam Perry Blvd
Fredericksburg, VA 22401-4453
Phone
(540) 741-1100
NPI assigned
Aug 7, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0024190890 VA Primary

Addresses

Primary practice location

1001 Sam Perry Blvd
Fredericksburg, VA 22401-4453

Mailing address

1001 Sam Perry Blvd
Fredericksburg, VA 22401-4453

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241125000713 VA Practitioner - Nurse Practitioner 1355876699 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mary Washington Healthcare PhysiciansGroup PAC ID 2769546530, 286 clinicians
Mary Washington Healthcare Providers LLCGroup PAC ID 1456629369, 264 clinicians

Practice addresses (Care Compare)

1001 Sam Perry Blvd
Fredericksburg, VA 22401-4453
Phone (540) 741-1100

1101 Sam Perry Blvd
Fredericksburg, VA 22401-4466
Phone (540) 741-2871

Hospital & facility affiliations

  • Mary Washington Hospital Hospital, Fredericksburg, VA, CCN 490022

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0024190890VAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mary Washington Healthcare Providers LLC CurrentSince Sep 21, 2025 Accepting new patients
Mary Washington Healthcare Physicians CurrentSince Oct 20, 2024 Accepting new patients
Pathology Associates of Fredericksburg PTR Current Accepting new patients
Mary Washington Healthcare Physicians CurrentSince Oct 20, 2024 Accepting new patients
Mary Washington Hospital Inc. PastSince Sep 21, 2025 Accepting new patients

Locations

1101 Sam Perry Blvd
Ste 400
Fredericksburg, VA 22401
Phone (540) 741-2865

1001 Sam Perry Blvd
Fredericksburg, VA 22401
Phone (540) 741-1100

120 Executive Center Pkwy
Ste 121
Fredericksburg, VA 22401

120 Executive Center Pkwy
Fredericksburg, VA 22401
Phone (540) 374-5097

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1722988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722988800000",
    "number": "1629808258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 SAM PERRY BLVD",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224014453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 SAM PERRY BLVD",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224014453",
            "telephone_number": "540-741-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LECKLITER",
        "first_name": "SHANA",
        "middle_name": "MARIE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-07",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024190890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fredericksburg, VA

Sources for this page

Verify at the official NPI Registry.