Active NPI
Jacqueline Phyllis Parks, RN
- Registered Nurse
- Fort Wayne, IN
National Provider Identifier
1154060028
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 28179527A
- Practice address
- 2121 Lake Ave
Fort Wayne, IN 46805-5100 - Phone
- (260) 426-5431
- Fax
- (260) 421-1092
- NPI assigned
- May 31, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 28179527A | IN | Primary |
Addresses
Primary practice location
2121 Lake Ave
Fort Wayne, IN 46805-5100
Mailing address
716 County Road 8
Corunna, IN 46730-9756
Phone (260) 318-1046
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28179527A | IN | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1653955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1653955200000",
"number": "1154060028",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "716 COUNTY ROAD 8",
"city": "CORUNNA",
"state": "IN",
"postal_code": "467309756",
"telephone_number": "260-318-1046"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2121 LAKE AVE",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468055100",
"telephone_number": "260-426-5431",
"fax_number": "260-421-1092"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PARKS",
"first_name": "JACQUELINE",
"middle_name": "PHYLLIS",
"name_prefix": "Mrs.",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-05-31",
"last_updated": "2022-05-31",
"certification_date": "2022-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "IN",
"license": "28179527A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.