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1043164155 NPI number — AVA RENEE PERRIN

NPI Number: 1043164155
Health Care Provider/Practitioner: AVA RENEE PERRIN

Information about “1043164155” NPI (AVA RENEE PERRIN) exists in 1043164155 in HTML format HTML  |  1043164155 in plain Text format TXT  |  1043164155 in PDF (Portable Document Format) PDF  |  1043164155 in an XML format XML  formats.

NPI Number : 1043164155 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1043164155",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PERRIN",
    "FirstName": "AVA",
    "MiddleName": "RENEE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5212 GRAPEVINE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WEST LAFAYETTE",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "47906-9044",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "765-404-3605",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "900 N JOHN R WOODEN DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WEST LAFAYETTE",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "47907-2117",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "800-497-7678",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/25/2026",
    "LastUpdateDate": "02/25/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2255A2300X",
        "TaxonomyName": "Athletic Trainer",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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