Healthcare Provider Details

I. General information

NPI: 1467124149
Provider Name (Legal Business Name): CLARE ANN CODDINGTON HECKATHORN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CLARE ANN CODDINGTON PAC

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11109 PARKVIEW PLAZA DR
FORT WAYNE IN
46845-1701
US

IV. Provider business mailing address

11109 PARKVIEW PLAZA DR # 117
FORT WAYNE IN
46845-1701
US

V. Phone/Fax

Practice location:
  • Phone: 260-672-6620
  • Fax: 260-672-6639
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10005183A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13867
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: