Healthcare Provider Details

I. General information

NPI: 1922827427
Provider Name (Legal Business Name): NICKI LOREAN SPECK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 W 86TH ST
INDIANAPOLIS IN
46260-1903
US

IV. Provider business mailing address

12433 CLARK ST APT 102
CARMEL IN
46032-7677
US

V. Phone/Fax

Practice location:
  • Phone: 317-872-8811
  • Fax:
Mailing address:
  • Phone: 317-413-5373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71015881A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number71015881A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71015881A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: