Nicole Leann Graham

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

71017022A Issued in IN

Practice address

3400 Lafayette Rd Ste 200
Indianapolis, IN 46222-1147

Phone

(317) 291-7422

Fax

(317) 291-7433

NPI assigned

Aug 15, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Shalom Health Care Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Indianapolis, IN
  • NPI 1538167036
  NPD (past)
• Shalom Health Care Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Indianapolis, IN
  • NPI 1982242327

  Pediatrics

  NPD (past)
• Shalom Health Care Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Indianapolis, IN
  • NPI 1992924633

  Pediatrics

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1723680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775174400000",
    "number": "1497587729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 LAFAYETTE RD STE 200",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462221147",
            "telephone_number": "317-291-7422",
            "fax_number": "317-291-7433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 LAFAYETTE RD STE 200",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462221147",
            "telephone_number": "317-291-7422",
            "fax_number": "317-291-7433"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1250 E Market St",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462023831",
            "country_code": "US",
            "telephone_number": "317-291-7422",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "705 Riley Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462025109",
            "country_code": "US",
            "telephone_number": "317-944-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "NICOLE",
        "middle_name": "LEANN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-08-15",
        "last_updated": "2026-04-03",
        "certification_date": "2026-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IN",
            "license": "71017022A",
            "primary": true
        },
        {
            "code": "163WP0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Pediatrics",
            "state": "IN",
            "license": "28275000A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jiya L Graham
• Joshua Steven Graham
• Kirsten P Graham, DT
• Larry Lloyd Graham, D.D.S
• Michael Q. Graham, M.D.
• Samantha M Graham, NP
• Shana P Graham, CERTIFIED NURSING AI
• Stephanie Graham, LCSW
• Steven Cromwell Graham, DDS
• Tamar Beatrice Graham, RBT

• Pediatric Nurse Practitioner in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Pediatric Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.