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1073307120 NPI number — ASHLEIGH JENAE DETRAY

NPI Number: 1073307120
Health Care Provider/Practitioner: ASHLEIGH JENAE DETRAY

Information about “1073307120” NPI (ASHLEIGH JENAE DETRAY) exists in 1073307120 in HTML format HTML  |  1073307120 in plain Text format TXT  |  1073307120 in PDF (Portable Document Format) PDF  |  1073307120 in an XML format XML  formats.

NPI Number : 1073307120 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1073307120",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DETRAY",
    "FirstName": "ASHLEIGH",
    "MiddleName": "JENAE",
    "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": "11109 PARKVIEW PLAZA DR # 117",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FORT WAYNE",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "46845-1701",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1115 S MAIN ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BLUFFTON",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "46714-3616",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "260-824-1071",
    "PracticeLocationAddressFaxNumber": "260-824-5578",
    "EnumerationDate": "04/05/2025",
    "LastUpdateDate": "02/11/2026",
    "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": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": "71017685A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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