MEDICARE: NICHOLLE LYNN BOOKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	013438	PA

General Provider Information

NPI Number	:	1376299461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLLE LYNN BOOKER

Provider Business Mailing Address
First Line	:	4616 W SAHARA AVE STE 242
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-3654
Country	:	US
Telephone Number	:	757-560-6677
Fax Number	:

Provider Business Practice Location Address
First Line	:	4616 W SAHARA AVE STE 242
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-3654
Country	:	US
Telephone Number	:	757-560-6677
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2022
Last Update Date	:	03/12/2026

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