Individual
HEATHER A ROY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11143 PARKVIEW PLAZA DR STE 200, FORT WAYNE, IN 46845-1728
(260) 266-8820
(260) 266-8829
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71009140A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200169400A
—
IN
Enumeration date
07/18/2019
Last updated
05/02/2024
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