Nickolas Lee Childress
Individual provider Active NPI Nurse Practitioner · Rochester, IN
NPI 1225906282 · NPPES record last updated Oct 29, 2025
Key facts
- NPI
- 1225906282
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 7101337A (IN)
- Practice address
- 392 Rochester Crossing Dr
Rochester, IN 46975-7034 - Phone
- (574) 325-5912
- NPI assigned
- Oct 29, 2025
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 35
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Fast Pace Medical Clinic PLLC
Cep America LLC
Practice addresses (Care Compare)
392 Rochester Crossing Dr
Rochester, IN 46975-7034
Phone (574) 325-5912
4152 W State Rd
Suite 56
Hanover, IN 47243-9070
Phone (901) 351-1791
5215 Holy Cross Pkwy
Mishawaka, IN 46545-1469
Phone (574) 335-2443
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251107001804 | IN | Practitioner - Nurse Practitioner | 1052801024 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7101337A | IN | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Upperline Healthcare, PC | Nurse Practitioner | Current |
Accepting new patients |
| Upperline Healthcare, PC | Current |
Accepting new patients | |
| Fast Pace Medical Clinic PLLC | Current |
Accepting new patients | |
| Fast Pace Medical Clinic PLLC | Current |
Accepting new patients |
Locations
1159 W Jefferson St
Ste 204
Franklin, IN 46131
4152 W State Road 56
Hanover, IN 47243
Phone (812) 762-4510
392 Rochester Crossing Dr
Rochester, IN 46975
Phone (574) 325-5192
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 7101337A | IN | Yes |
Addresses
Primary practice location
392 Rochester Crossing Dr
Rochester, IN 46975-7034
Mailing address
392 Rochester Crossing Dr
Rochester, IN 46975-7034
Phone (574) 325-5912
Other providers in Rochester, IN
- Aaron J Brown
- Michael J Brubaker
- Craig A Bugno
- Cardinal Center, Inc.
- Mendi Lynn Carroll
- Franklin Edward Choate
- William Everett Clymer III
- Susan Coby
- Randell J Coulter
- August Cox
All providers in Rochester, IN · Nurse Practitioner in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 29, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.