Provider Demographics
NPI:1386661064
Name:PARKER, MARY CATHERINE (MSN, GNP-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:PARKER
Suffix:
Gender:F
Credentials:MSN, GNP-C
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CATHERINE
Other - Last Name:YAGGY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5027 WOOD MANOR RUN
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-8828
Mailing Address - Country:US
Mailing Address - Phone:260-492-2599
Mailing Address - Fax:260-485-0447
Practice Address - Street 1:2001 HOBSON RD
Practice Address - Street 2:HERITAGE PARK
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4872
Practice Address - Country:US
Practice Address - Phone:260-484-9557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000897A363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200273780Medicaid
IN224350AMedicare ID - Type Unspecified
IN200273780Medicaid