Amanda M Leisure, CPNP-AC/PC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

71006767 Issued in IN

Practice address

11141 Parkview Plaza Dr Ste 210
Fort Wayne, IN 46845-1714

Phone

(260) 266-5400

Fax

(260) 266-5409

NPI assigned

Oct 19, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Amanda M Wagner Former name

Electronic endpoints 3

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: awagner105133@direct.parkviewexchange.com

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.

• Parkview Health System Inc

  • Family Medicine Physician
  • Fort Wayne, IN
  • NPI 1932130952
  Medicare reassignment NPD
• Parkview Health System, Inc.

  • Internal Medicine Physician
  • Fort Wayne, IN
  • NPI 1952411233
  NPD (past)

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

{
    "created_epoch": "1476835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665360000000",
    "number": "1154872653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11109 PARKVIEW PLAZA DR # 117",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11141 PARKVIEW PLAZA DR STE 210",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451714",
            "telephone_number": "260-266-5400",
            "fax_number": "260-266-5409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEISURE",
        "first_name": "AMANDA",
        "middle_name": "M",
        "name_prefix": "Miss",
        "credential": "CPNP-AC/PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-19",
        "last_updated": "2022-10-10",
        "certification_date": "2022-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IN",
            "license": "71006767",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "awagner105133@Direct.Parkviewexchange.com",
            "affiliation": "N",
            "address_1": "11141 Parkview Plaza Dr Ste 210",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468451714",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicprod-mobile.parkview.com/FHIR/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "11141 Parkview Plaza Dr Ste 210",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468451714",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicprod-mobile.parkview.com/FHIR/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "11141 Parkview Plaza Dr Ste 210",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468451714",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "WAGNER",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Amber Leighty
• Brooke Ann Leininger
• Kayla Leininger, NP
• Laura Jean Leins, LMHC
• Leslie Leins, PHARMD
• Rosemary E Leitch, M.D.
• Allie Leja
• Tara Lynn Leland, NP-C
• Mary Jo Lelonek
• Charla Leman, LCSW

• Pediatric Nurse Practitioner in Fort Wayne, IN
• Providers in Fort Wayne, 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 Oct 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.