MEDICARE: EMILY NICOLE HACKETT

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	71011278A	IN

General Provider Information

NPI Number	:	1881207983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY NICOLE HACKETT

Provider Business Mailing Address
First Line	:	10909 W SYCAMORE HILLS DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46814-9335
Country	:	US
Telephone Number	:	260-446-1512
Fax Number	:

Provider Business Practice Location Address
First Line	:	1942 E DUPONT RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1582
Country	:	US
Telephone Number	:	260-203-9961
Fax Number	:

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

Provider Enumeration Date	:	08/28/2020
Last Update Date	:	11/04/2025

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Directions to “ EMILY NICOLE HACKETT ” Practice Location

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