Healthcare Provider Details

I. General information

NPI: 1114395738
Provider Name (Legal Business Name): NICOLE CHILES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 SHADOW MOSS DR
LINCOLN NE
68521-8960
US

IV. Provider business mailing address

1260 SHADOW MOSS DR
LINCOLN NE
68521-8960
US

V. Phone/Fax

Practice location:
  • Phone: 402-429-1008
  • Fax:
Mailing address:
  • Phone: 402-429-1008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2401
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: