MEDICARE: APRIL SUSAN PARKS FNP

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	363LF0000X	Family Nurse Practitioner	4704303374	MI
2	363LF0000X	Family Nurse Practitioner	71001557	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000284090	OTHER	IN	ATHEM
2	00000634021	OTHER	IN	ANTHEM
3	000000642286	OTHER	IN	ANTHEM
4	080F360200	OTHER	MI	BCBSM GROUP
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205825429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	APRIL SUSAN PARKS FNP

Provider Business Mailing Address
First Line	:	9240 N MERIDIAN ST STE 160
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1827
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9240 N MERIDIAN ST STE 160
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1827
Country	:	US
Telephone Number	:	317-415-6230
Fax Number	:

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

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	09/14/2023

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