Active NPI
Gay Gundersen Watson, RN FNP
- Family Nurse Practitioner
- Fort Wayne, IN
National Provider Identifier
1164784518
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 71004003A
- Practice address
- 7900 W Jefferson Blvd Ste 304
Fort Wayne, IN 46804-4128 - Phone
- (260) 969-6200
- Fax
- (260) 969-6201
- NPI assigned
- Jun 12, 2012
- Last updated
- Aug 13, 2013
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 28161069A | IN | |
| Family Nurse Practitioner | 363LF0000X | 71004003A | IN | Primary |
Addresses
Primary practice location
7900 W Jefferson Blvd Ste 304
Fort Wayne, IN 46804-4128
Mailing address
PO Box 8857
Fort Wayne, IN 46898-8857
Phone (260) 969-6200
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201092300 | Medicaid | IN | |
| 000000780053 | Other | IN | ANTHEM |
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, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28161069A | IN | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lima Memorial Joint Operating Company | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Lima Memorial Health System
- General Acute Care Hospital
- Lima, OH
- NPI 1336144732
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339459200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1376352000000",
"number": "1164784518",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8857",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468988857",
"telephone_number": "260-969-6200",
"fax_number": "260-969-6201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7900 W JEFFERSON BLVD STE 304",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468044128",
"telephone_number": "260-969-6200",
"fax_number": "260-969-6201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUNDERSEN WATSON",
"first_name": "GAY",
"name_prefix": "Ms.",
"credential": "RN FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-12",
"last_updated": "2013-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "IN",
"license": "28161069A",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "IN",
"license": "71004003A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "201092300",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000780053",
"state": "IN"
}
],
"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 Aug 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.