{
"Npi": {
"NPI": "1184185282",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "RAY",
"FirstName": "KRYSTLE",
"MiddleName": null,
"NamePrefix": "MS.",
"NameSuffix": null,
"Credential": "APRN",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "RAY",
"OtherFirstName": "KRYSTLE",
"OtherMiddleName": "MARIE",
"OtherNamePrefix": "MS.",
"OtherNameSuffix": null,
"OtherCredential": "KRYSTLE RAY, FNP",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "261 N ROOSEVELT AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHANDLER",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85226-2617",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "480-677-8282",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4707 E BELL RD # C-3",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PHOENIX",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "85032-2307",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "480-677-8282",
"PracticeLocationAddressFaxNumber": "480-535-0962",
"EnumerationDate": "03/29/2019",
"LastUpdateDate": "09/04/2024",
"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": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "255663",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}