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NPI Code Detail

MEDICARE: ASHLEIGH JENAE DETRAY

MEDICARE: ASHLEIGH JENAE DETRAY
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
1390200000XStudent in an Organized Health Care Education/Training Program
2363L00000XNurse Practitioner71017685AIN

General Provider Information

NPI Number : 1073307120
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEIGH JENAE DETRAY
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 : 1115 S MAIN ST
Second Line :
City : BLUFFTON
State : IN
Zip : 46714-3616
Country : US
Telephone Number : 260-824-1071
Fax Number : 260-824-5578
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2025
Last Update Date : 02/11/2026

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Directions to “ ASHLEIGH JENAE DETRAY ” Practice Location

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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.

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