Healthcare Provider Details

I. General information

NPI: 1508454778
Provider Name (Legal Business Name): VICKI LYNN LEDERLE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 S DIXON RD STE 430
KOKOMO IN
46902-6428
US

IV. Provider business mailing address

9011 N MERIDIAN ST STE 225
INDIANAPOLIS IN
46260-5365
US

V. Phone/Fax

Practice location:
  • Phone: 765-445-3120
  • Fax: 765-453-6889
Mailing address:
  • Phone: 317-574-4747
  • Fax: 317-574-4737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71010807A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: