Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Stacy L Roark

Individual provider Nurse Practitioner · NPI 1417495078

Stacy L Roark is a Nurse Practitioner in Fort Wayne, Indiana. Qualified in 2016, 10 years ago. Practices with Parkview Health System Inc, a 1,336-clinician group and accepts Medicare assignment. Licensed in Indiana.

Years since qualifying
10
Licensed in
IN
In the registry since
2017
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Practice location Address checks out

11109 Parkview Plaza Dr
Fort Wayne, IN 46845-1701
Phone: (260) 672-6620
Fax: (260) 672-6639
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 71007073A (IN)

Record details

NPI number1417495078
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedFebruary 3, 2017
Last updated in NPPESOctober 10, 2022
Certification dateOctober 10, 2022
Mailing address11109 Parkview Plaza Dr # 117, Fort Wayne, IN 46845-1701

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Group practice Parkview Health System Inc — 1336 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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