Active NPI
Kelly Wakefield, APRN.CNP
- Women's Health Nurse Practitioner
- Fort Wayne, IN
National Provider Identifier
1164073557
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Women's Health Nurse Practitioner
- License
- 71009784A
- Practice address
- 2700 Lafayette St
Fort Wayne, IN 46806-1100 - Phone
- (260) 702-4404
- Fax
- (260) 744-3006
- NPI assigned
- Sep 26, 2019
- 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 |
|---|---|---|---|---|
| Women's Health Nurse Practitioner | 363LW0102X | 71009784A | IN | Primary |
Addresses
Primary practice location
2700 Lafayette St
Fort Wayne, IN 46806-1100
Mailing address
2700 Lafayette St
Fort Wayne, IN 46806-1100
Phone (260) 702-4404
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71009784A | IN | MD | Women's Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1569456000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1581379200000",
"number": "1164073557",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2700 LAFAYETTE ST",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468061100",
"telephone_number": "260-702-4404",
"fax_number": "260-744-3006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2700 LAFAYETTE ST",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468061100",
"telephone_number": "260-702-4404",
"fax_number": "260-744-3006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAKEFIELD",
"first_name": "KELLY",
"credential": "APRN.CNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-09-26",
"last_updated": "2020-02-11",
"certification_date": "2020-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "363LW0102X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Women's Health",
"state": "IN",
"license": "71009784A",
"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 Feb 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.