Active NPI
Carol Lynn Parks
- Family Nurse Practitioner
- Michigan City, IN
National Provider Identifier
1013100775
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 71002473A
- Practice address
- 1225 E Coolspring Ave
2-E
Michigan City, IN 46360-6312 - Phone
- (219) 879-6531
- NPI assigned
- Aug 24, 2007
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 71002473A | IN | Primary |
Addresses
Primary practice location
1225 E Coolspring Ave
2-E
Michigan City, IN 46360-6312
Mailing address
PO Box 781076
Detroit, MI 48278-1076
Other practice location 1
7865 Grand Blvd
Hobart, IN 46342-6665
Phone (219) 945-0669
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200923670 | Medicaid | IN |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | cparks91462@Direct.FranciscanAlliance.org | Direct |
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)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71002473A | IN | MD | Family Nurse Practitioner |
Interoperability endpoints
- cparks91462@direct.franciscanalliance.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1187913600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615420800000",
"number": "1013100775",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 781076",
"city": "DETROIT",
"state": "MI",
"postal_code": "482781076"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1225 E COOLSPRING AVE",
"address_2": "2-E",
"city": "MICHIGAN CITY",
"state": "IN",
"postal_code": "463606312",
"telephone_number": "219-879-6531"
}
],
"practiceLocations": [
{
"address_1": "7865 Grand Blvd",
"address_purpose": "LOCATION",
"city": "Hobart",
"state": "IN",
"postal_code": "463426665",
"country_code": "US",
"telephone_number": "219-945-0669",
"fax_number": "219-945-5669",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PARKS",
"first_name": "CAROL",
"middle_name": "LYNN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-08-24",
"last_updated": "2021-03-11",
"certification_date": "2021-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "IN",
"license": "71002473A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200923670",
"state": "IN"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "cparks91462@Direct.FranciscanAlliance.org",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "1225 E Coolspring Ave",
"address_2": "2-E",
"city": "Michigan City",
"state": "IN",
"country_code": "US",
"postal_code": "463606312",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Michigan City, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.