MEDICARE: NICKI INDUSTRIES LLC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1639013436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICKI INDUSTRIES LLC

Provider Business Mailing Address
First Line	:	35 WEST ST
Second Line	:
City	:	FERNLEY
State	:	NV
Zip	:	89408-7671
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 WEST ST
Second Line	:
City	:	FERNLEY
State	:	NV
Zip	:	89408-7671
Country	:	US
Telephone Number	:	775-444-1804
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ OFFICE MANAGER
Name	:	NICOLE MITCHELL
Credential	:
Telephone Number	:	775-600-7025

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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Directions to “NICKI INDUSTRIES LLC ” Practice Location

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