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1487368197 NPI number — INDYA ELIZABETH PERRY FNP-BC

NPI Number: 1487368197
Health Care Provider/Practitioner: INDYA ELIZABETH PERRY FNP-BC

Information about “1487368197” NPI (INDYA ELIZABETH PERRY FNP-BC) exists in 1487368197 in HTML format HTML  |  1487368197 in plain Text format TXT  |  1487368197 in PDF (Portable Document Format) PDF  |  1487368197 in an XML format XML  formats.

NPI Number : 1487368197 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1487368197",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PERRY",
    "FirstName": "INDYA",
    "MiddleName": "ELIZABETH",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "FNP-BC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "22945 N BELLWOOD DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SOUTHFIELD",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48034-6228",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "248-506-0549",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "22201 MOROSS RD",
    "SecondLinePracticeLocationAddress": "ST JOHN PROF BLDG STE 170",
    "PracticeLocationAddressCityName": "DETROIT",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48236-2152",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "313-886-8787",
    "PracticeLocationAddressFaxNumber": "313-887-4103",
    "EnumerationDate": "01/09/2023",
    "LastUpdateDate": "08/21/2025",
    "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": "4704317313",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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