Individual provider Active NPI

Marybeth Witcher, F.N.P.

  • Family Nurse Practitioner
  • Valparaiso, IN
National Provider Identifier
1629120878
Registry record updated Jun 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71000341A Issued in IN
Practice address
1001 Sturdy Rd
Valparaiso, IN 46383-4126
Phone
(219) 462-7173
Fax
(219) 462-7504
NPI assigned
Jan 17, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 71000341A IN Primary

Addresses

Primary practice location

1001 Sturdy Rd
Valparaiso, IN 46383-4126

Mailing address

951 Transport Dr
Valparaiso, IN 46383-8434
Phone (219) 477-6082

Other identifiers 1

IdentifierTypeStateIssuer
200321550AMedicaidIN

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20110906000615 IN Practitioner - Nurse Practitioner 6507036217 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
71000341AINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Healthlinc, Inc. CurrentSince Jul 26, 2011 Accepting new patients
Healthlinc, Inc CurrentSince Jul 26, 2011 Accepting new patients

Locations

1001 Sturdy Rd
Valparaiso, IN 46383
Phone (219) 462-7173

951 Transport Dr
Valparaiso, IN 46383
Phone (219) 464-4100

2401 Valley Dr
Valparaiso, IN 46383
Phone (219) 413-5100

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466380800000",
    "number": "1629120878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "951 TRANSPORT DR",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463838434",
            "telephone_number": "219-477-6082",
            "fax_number": "219-465-9502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 STURDY RD",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463834126",
            "telephone_number": "219-462-7173",
            "fax_number": "219-462-7504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITCHER",
        "first_name": "MARYBETH",
        "credential": "F.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-17",
        "last_updated": "2016-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71000341A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200321550A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Valparaiso, IN

Sources for this page

Verify at the official NPI Registry.