Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Stacy Nicole Nicole

Individual provider Registered Nurse · NPI 1891516167

Stacy Nicole Nicole is a Nurse Practitioner in Fort Wayne, Indiana. Qualified in 2024, 2 years ago. Practices with Parkview Health System Inc, a 1,336-clinician group and accepts Medicare assignment. Licensed in Indiana.

Years since qualifying
2
Licensed in
IN
In the registry since
2024
Specialties on file
2
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Practice location Address checks out

3909 New Vision Dr
Fort Wayne, IN 46845-1725
Phone: (260) 469-6610
Fax: (260) 969-3065
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 71016044A (IN)
Registered Nurse Taxonomy 163W00000X · Licence 28147485A (IN)

Record details

NPI number1891516167
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedOctober 21, 2024
Last updated in NPPESMarch 3, 2025
Certification dateMarch 3, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Parkview Health System Inc — 1336 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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