MCKENNA A GOTTFRIED (NPI# 1003328592) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003328592 |
| Entity Type | Individual |
| Full Name | MCKENNA A GOTTFRIED |
| Practice Address |
5693 Ymca Park Dr W Fort Wayne IN 46835-3280 |
| Mailing Address |
3702 New Vision Dr Bldg B Fort Wayne IN 46845-1703 |
| Practice Telephone | 2604256500 |
| Enumeration Date | 2017-10-25 |
| Last Update Date | 2017-11-20 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 28194377A | IN | Nursing Service Providers |
| Y | 363L00000X | Nurse Practitioner | 71007667A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
5693 YMCA PARK DR W |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46835-3280 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891060075 | Amanda J Patch | Family Medicine | 5693 Ymca Park Dr W, Fort Wayne, IN 46835-3280 | 2012-03-20 |
| 1851944953 | Mary Jo Cochran | Registered Nurse | 5693 Ymca Park Dr W, Fort Wayne, IN 46835-3280 | 2019-07-18 |
| 1942799192 | Lorin Yolch | Pharmacist | 5693 Ymca Park Dr W, Fort Wayne, IN 46835-3280 | 2018-05-03 |
| 1538680152 | Rachel Steele | Pharmacist | 5693 Ymca Park Dr W, Fort Wayne, IN 46835-3280 | 2017-07-05 |
| 1609281682 | Emily Miranda Bushey | Family Medicine | 5693 Ymca Park Dr W, Fort Wayne, IN 46835-3280 | 2014-06-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760993810 | Longe Enterprises Corp | Eyewear Supplier (Equipment, not the service) | 5711 Ymca Park Dr East, Fort Wayne, IN 46835 | 2017-10-17 |
| 1801144464 | Tracey Gordon | Physical Therapy Assistant | 2827 Northgate Boulevard, Fort Wayne, IN 46835 | 2012-08-29 |
| 1316179682 | Janet L Daniel | Counselor | 310 E Dupont Road, Suite 2, Fort Wayne, IN 46835 | 2009-08-20 |
| 1083868863 | Nicholas Joseph Sullivan | Chiropractor | 8320 Chapel Bend Drive, Fort Wayne, IN 46835 | 2008-11-06 |
| 1497922090 | Michelle A Bailey | Registered Nurse | 6108 Maplecrest Road, Fort Wayne, IN 46835 | 2008-05-13 |
| 1073789954 | Charles Arthur Bolinger | Technician, Other | 4546 Maplecrest Rd, Ft Wayne, IN 46835 | 2008-05-01 |
| 1851469878 | Richard J Klaehn | Optometrist | 4536 Maplecrest Road, Ft. Wayne, IN 46835 | 2006-11-30 |
| 1639272339 | Hook Superx LLC | Durable Medical Equipment & Medical Supplies | 6220 St Joseph Center Rd, Fort Wayne, IN 46835 | 2006-09-07 |
| 1275649014 | Adrienne Meyer | Pharmacist | 7909 Brixham Place, Fort Wayne, IN 46835 | 2006-08-22 |
| 1750378147 | The Health and Hospital Corporation of Marion County | Skilled Nursing Facility | 4430 Elsdale Dr, Fort Wayne, IN 46835 | 2005-09-30 |
| Find all providers in zip 46835 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891394599 | Laury Farrell | Nurse Practitioner | 6017 Stoney Creek Dr, Fort Wayne, IN 46825-4410 | 2020-10-22 |
| 1730787599 | Crystal Neal | Nurse Practitioner | 4430 Keeneland Ln Unit 202, Fort Wayne, IN 46845-1985 | 2020-10-14 |
| 1225668312 | Kathleen Vanderreyden | Nurse Practitioner | 3005 E State Blvd, Fort Wayne, IN 46805-4736 | 2020-01-17 |
| 1043703903 | Kara Stackhouse | Nurse Practitioner | 11050 Parkview Plaza Drive, Fort Wayne, IN 46845 | 2018-06-14 |
| 1275980690 | April Anderson | Nurse Practitioner | 6920 Pointe Inverness Way Ste 120, Fort Wayne, IN 46804-7926 | 2016-05-16 |
| 1922470970 | Jennifer Carol Littke | Nurse Practitioner | 6326 Constitution Dr, Fort Wayne, IN 46804-1518 | 2015-10-28 |
| 1275956054 | Andrea N Lahrman | Nurse Practitioner | 11123 Parkview Plaza Dr Ste 106, Fort Wayne, IN 46845-1707 | 2014-01-29 |
| 1417213729 | Laura Beth Baker | Nurse Practitioner | 5750 Falls Drive, Fort Wayne, IN 46804-7147 | 2012-04-11 |
| 1447572441 | Kathryn L Smith | Nurse Practitioner | 11104 Parkview Circle Dr Ste 20, Fort Wayne, IN 46845-1733 | 2010-02-18 |
| 1316180144 | Braden M Butterfield Mckinley | Nurse Practitioner | 2101 E Coliseum Blvd Rm 234, Fort Wayne, IN 46805-1445 | 2009-04-09 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46835 |
Please comment or provide details below to improve the information on MCKENNA A GOTTFRIED.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.