MEDICARE: SARA K FORD-TERRY FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	71015315A	IN

General Provider Information

NPI Number	:	1518746502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA K FORD-TERRY FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 208
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46801-0208
Country	:	US
Telephone Number	:	260-436-8686
Fax Number	:

Provider Business Practice Location Address
First Line	:	11123 PARKVIEW PLAZA DR STE 102
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1707
Country	:	US
Telephone Number	:	260-425-5240
Fax Number	:	260-425-5245

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2023
Last Update Date	:	03/05/2026

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