MEDICARE: AUDRA RENAE DEARDORF 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	363LF0000X	Family Nurse Practitioner	AP137752	TX
2	363L00000X	Nurse Practitioner	71015231A	IN

General Provider Information

NPI Number	:	1467946111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDRA RENAE DEARDORF FNP-C

Provider Business Mailing Address
First Line	:	11109 PARKVIEW PLAZA DR # 117
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	128 N RANDOLPH ST
Second Line	:
City	:	GARRETT
State	:	IN
Zip	:	46738-1138
Country	:	US
Telephone Number	:	260-357-6557
Fax Number	:	260-357-0373

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

Provider Enumeration Date	:	06/17/2018
Last Update Date	:	04/29/2025

Similar Medicare Providers

1740273739 — DR. GREGORY L. SWARTZ DO
Practice Location Address:

128 N RANDOLPH ST
GARRETT, IN
46738-1138

Practice Phone: 260-357-6557
Practice Fax: 260-357-0373

1104808005 — KRISTI A MORRIS NP-C
Practice Location Address:

128 N RANDOLPH ST
GARRETT, IN
46738-1138

Practice Phone: 260-357-6557
Practice Fax: 260-357-0373

1922078062 — MR. BRET D KUEBER M.D.
Practice Location Address:

128 N. RANDOLPH STREET
GARRETT, IN
46738-1138

Practice Phone: 260-357-6557
Practice Fax: 260-357-0373

1508937376 — DEKALB MEMORIAL HOSPITAL, INC
Practice Location Address:

128 N RANDOLPH ST
GARRETT, IN
46738-1138

Practice Phone: 260-357-6557
Practice Fax: 260-357-0373

1295985828 — GRETCHEN HEIDI JENKINS FNP-C
Practice Location Address:

128 N RANDOLPH ST
GARRETT, IN
46738-1138

Practice Phone: 260-235-7655
Practice Fax: 260-357-0373

1528479946 — MA UMIYA LLC
Practice Location Address:

112 N RANDOLPH ST
GARRETT, IN
46738-1138

Practice Phone: 260-357-0111
Practice Fax: 260-357-0122

Directions to “ AUDRA RENAE DEARDORF FNP-C” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.