Active NPI
Nicole R Valencia, LPN
- Licensed Practical Nurse
- Indianapolis, IN
National Provider Identifier
1174106488
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 27068962A
- Practice address
- 4010 W 86TH St Ste D
Indianapolis, IN 46268-1779 - Phone
- (317) 647-0102
- Fax
- (317) 868-7447
- NPI assigned
- May 4, 2021
- Last updated
- Dec 31, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 27068962A | IN | Primary |
Addresses
Primary practice location
4010 W 86TH St Ste D
Indianapolis, IN 46268-1779
Mailing address
4010 W 86TH St Ste D
Indianapolis, IN 46268-1779
Phone (317) 647-0102
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27068962A | IN | MD | Licensed Practical Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Valle Vista LLC | Current | Accepting new patients |
Locations
4010 W 86th St
Ste D
Indianapolis, IN 46268
Phone (317) 647-0102
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1620086400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1767139200000",
"number": "1174106488",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4010 W 86TH ST STE D",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462681779",
"telephone_number": "317-647-0102",
"fax_number": "317-868-7447"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4010 W 86TH ST STE D",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462681779",
"telephone_number": "317-647-0102",
"fax_number": "317-868-7447"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VALENCIA",
"first_name": "NICOLE",
"middle_name": "R",
"credential": "LPN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-05-04",
"last_updated": "2025-12-31",
"certification_date": "2025-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "IN",
"license": "27068962A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.