KELLY MARIE VANDEMARK (NPI# 1851916274) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851916274 |
| Entity Type | Individual |
| Full Name | KELLY MARIE VANDEMARK |
| Credential | NP |
| Practice Address |
1717 S Calhoun St Fort Wayne IN 46802-5257 |
| Practice Telephone | 2604583093 |
| Practice Fax Number | 2604583093 |
| Mailing Telephone | 2604582641 |
| Mailing Fax Number | 2604583093 |
| Enumeration Date | 2020-06-11 |
| Last Update Date | 2020-06-11 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
71010093A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3350 E Paulding Rd, Fort Wayne, IN 468164513 | 2604582641 |
| Street Address |
1717 S CALHOUN ST |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46802-5257 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003810656 | Ronald R Hall | Pediatrics | 1717 S Calhoun St, Fort Wayne, IN 46802-5257 | 2005-06-10 |
| 1558960179 | Omolola Beaird | Nurse Practitioner | 1717 S Calhoun St, Fort Wayne, IN 46802-5257 | 2020-10-24 |
| 1689287518 | Brianna Rae Pool | Nurse Practitioner | 1717 S Calhoun St, Fort Wayne, IN 46802-5257 | 2020-08-29 |
| 1922631332 | Neighborhood Health Clinics, Inc | Community/Behavioral Health | 1717 S Calhoun St, Fort Wayne, IN 46802-5257 | 2020-02-14 |
| 1821646795 | Marta E. Wrobleski | Nurse Practitioner | 1717 S Calhoun St, Fort Wayne, IN 46802-5257 | 2019-09-03 |
| 1912462698 | Lormekia Al'mata Warren | Nurse Practitioner | 1717 S Calhoun St, Fort Wayne, IN 46802-5257 | 2019-02-06 |
| 1720599988 | Neighborhood Health Clinics, Inc | Optometrist | 1717 S Calhoun St, Fort Wayne, IN 46802-5257 | 2017-10-16 |
| 1801324470 | Kristen Nicole Brunner | Dentist | 1717 S Calhoun St, Fort Wayne, IN 46802-5257 | 2017-05-26 |
| 1043766421 | Allison Treleaven | Optometrist | 1717 S Calhoun St, Fort Wayne, IN 46802 | 2016-08-26 |
| 1104272145 | Jonathan Hinz | Dentist | 1717 S Calhoun St, Fort Wayne, IN 46802 | 2016-05-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568084416 | Renaissance Counseling Center,llc | Community/Behavioral Health | 1210 Guthrie St, Fort Wayne, IN 46802 | 2020-05-14 |
| 1699260182 | Tina Huffman Counseling Services LLC | Clinic/Center | 2323 111 W. Berry St., Fort Wayne, IN 46802 | 2018-06-27 |
| 1669879664 | Neighborhood Health Clinics, Inc | Clinic/Center | 1721 S Calhoun St, Fort Wayne, IN 46802 | 2014-11-20 |
| 1205272168 | Tyler Jerome Kimmel | Dentist | 1717 S. Calhoun Street, Fort Wayne, IN 46802 | 2013-05-20 |
| 1174899405 | Hearcare Connection, Inc. | Audiologist | 130 W Main St Ste 150, Fort Wayne, IN 46802 | 2012-03-30 |
| 1801114533 | Hoosier Sports & Chiropractic LLC | Chiropractor | 122 W Wayne Street, Fort Wayne, IN 46802 | 2010-05-05 |
| 1891912523 | Krista Lohmar | Speech-Language Pathologist | 3340 North Washington Road, Ft. Wayne, IL 46802 | 2007-04-20 |
| 1811047608 | Catholic Charities of The Diocese of Fort Wayne-south Bend, Inc. | Counselor | 915 South Clinton, Fort Wayne, IN 46802 | 2007-01-12 |
| 1548323801 | Clifford T Salk | Dentist | 122 W Washington Blvd, Fort Wayne, IN 46802 | 2006-12-18 |
| 1720155492 | Kristina Wise | Social Worker | 203 W Wayne St Ste 317, Fort Wayne, IN 46802 | 2006-11-29 |
| Find all providers in zip 46802 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518566397 | Stacey Renee Pulver | Nurse Practitioner | 13134 Hollow Oak Rd, Fort Wayne, IN 46845-2327 | 2020-10-22 |
| 1649878554 | Heather Ormiston-leclear | Nurse Practitioner | 3800 N Anthony Blvd # Cc1335, Fort Wayne, IN 46805-1430 | 2020-10-13 |
| 1669081618 | Carly Ann Nahrwold | Nurse Practitioner | 7025 Old Trail Rd # 9574, Fort Wayne, IN 46809-2713 | 2020-07-27 |
| 1932725942 | Health Essential LLC | Nurse Practitioner | 3030 Lake Ave Ste 14, Fort Wayne, IN 46805-5428 | 2020-06-25 |
| 1942824842 | Carissa Miller | Nurse Practitioner | 707 Rollingwood Ln, Fort Wayne, IN 46845-1088 | 2020-06-05 |
| 1891329819 | Jasmine Monae Tubbs | Nurse Practitioner | 875 Petal Way, Fort Wayne, IN 46816-8900 | 2020-02-28 |
| 1235780362 | Elizabeth Rose Lichtsinn | Nurse Practitioner | 3919 W Jefferson Blvd Ste 200, Fort Wayne, IN 46804-6811 | 2019-09-20 |
| 1033676275 | Amanda Warner | Nurse Practitioner | 2229 Woods Rd, Fort Wayne, IN 46818-9539 | 2019-02-25 |
| 1669940714 | Brookelyn Agler | Nurse Practitioner | Summit Radiology, PC, 5001 Us Highway 30 W, Suite D, Fort Wayne, IN 46818-9701 | 2018-11-07 |
| 1346731908 | Erin Nicole Zimmerman | Nurse Practitioner | 10170 Illinois Rd # 14, Fort Wayne, IN 46804 | 2018-05-19 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46802 |
Please comment or provide details below to improve the information on KELLY MARIE VANDEMARK.
| 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.