Individual provider · Type 1 NPI

Jacob C. Shively

Nurse Practitioner · Fort Wayne, IN

NPI number 1215672928 Active

Practice location

11104 Parkview Circle Dr Ste 330
Fort Wayne, IN 46845-1674

Call (260) 494-3484 Map

Fax (260) 969-0188

Mailing address

120 W 22nd St Ste 200
Oak Brook, IL 60523-1563

Other practice locations

  • 11104 Parkview Circle Dr Ste 110, Fort Wayne, IN 46845-1673 · (260) 425-6780

Specialties and licenses

TaxonomyCodeLicense
Nurse Practitioner Primary 363L00000X71012742A (IN)

Nurse Practitioner: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance wit…

7 other providers at this address

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About NPI 1215672928

Jacob C. Shively's National Provider Identifier is 1215672928, issued on Apr 28, 2022. The primary taxonomy on file is Nurse Practitioner (363L00000X), and the practice location is in Fort Wayne, IN. The record was last updated on Nov 1, 2023.