Individual provider Active NPI

Mary Beth Parks, APRN

  • Family Nurse Practitioner
  • Fort Myers, FL
National Provider Identifier
1790735736
Registry record updated Jan 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN11009513 Issued in FL
Practice address
8960 Colonial Center Dr Ste 300
Fort Myers, FL 33905-7810
Phone
(239) 343-9470
Fax
(239) 343-9498
NPI assigned
May 11, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APRN11009513 FL Primary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X APN8135 TN
Family Nurse Practitioner 363LF0000X APN8135 TN

Addresses

Primary practice location

8960 Colonial Center Dr Ste 300
Fort Myers, FL 33905-7810

Mailing address

PO Box 2147
Fort Myers, FL 33902-2147
Phone (239) 343-9470

Other identifiers 1

IdentifierTypeStateIssuer
112420100MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mparks279035@Direct.leememorial.org Direct Lee Memorial Health System

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20211013001399 FL Practitioner - Nurse Practitioner 1456368257 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lee Health System IncGroup PAC ID 9335672146, 1,381 clinicians

Practice addresses (Care Compare)

1138 Country Club Blvd
Cape Coral, FL 33990-3027
Phone (239) 424-1900

8960 Colonial Ctr Dr
Fort Myers, FL 33905-7810

Hospital & facility affiliations

  • Lee Memorial Home Health, Inc. Home health agency, Fort Myers, FL, CCN 107191
  • Aveanna Home Health Home health agency, Sarasota, FL, CCN 108480
  • Lee Memorial Hospital Hospital, Fort Myers, FL, CCN 100012
  • Cape Coral Hospital Hospital, Cape Coral, FL, CCN 100244
  • Gulf Coast Medical Center Lee Health Hospital, Fort Myers, FL, CCN 100220

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APN8135TNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Lee Health System Inc CurrentSince Oct 1, 2024 Accepting new patients
Lee Memorial Health System CurrentSince Dec 1, 2021 Accepting new patients
Lee Health System Inc CurrentSince Oct 1, 2024 Accepting new patients
Lee Memorial Health System Current Accepting new patients
Lee Memorial Health System CurrentSince Dec 1, 2021 Accepting new patients
Forrest Kenton Busch, D.O. P.C. Past Accepting new patients
Mental Health Centers & Clinics of Tennessee PastSince May 24, 2010 Accepting new patients

Locations

1138 Country Club Blvd
Cape Coral, FL 33990
Phone (239) 424-1900

1569 Matthew Dr
Fort Myers, FL 33907
Phone (941) 939-1700

2776 Cleveland Ave
Fort Myers, FL 33901
Phone (239) 343-2000

8931 Colonial Center Dr
Ste 401
Fort Myers, FL 33905
Phone (239) 424-2030

8960 Colonial Center Dr
Ste 300
Fort Myers, FL 33905
Phone (239) 343-9470

930 S Main St
Ste C
Labelle, FL 33935
Phone (239) 674-5520

Interoperability endpoints

  • Direct secure messaging: mparks279035@direct.leememorial.org

Organizations & group practices 7

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641427200000",
    "number": "1790735736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2147",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339022147",
            "telephone_number": "239-343-9470",
            "fax_number": "239-343-9498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8960 COLONIAL CENTER DR STE 300",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339057810",
            "telephone_number": "239-343-9470",
            "fax_number": "239-343-9498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARKS",
        "first_name": "MARY",
        "middle_name": "BETH",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-11",
        "last_updated": "2022-01-06",
        "certification_date": "2022-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN11009513",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TN",
            "license": "APN8135",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "APN8135",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112420100",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mparks279035@Direct.leememorial.org",
            "affiliation": "Y",
            "affiliationName": "Lee Memorial Health System",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2776 Cleveland Ave",
            "city": "Fort Myers",
            "state": "FL",
            "country_code": "US",
            "postal_code": "339015864",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.