NPI |
1922437482 |
The date that a record was last updated or changed. |
Entity Type Code |
1 |
The code designating the provider’s gender if the provider is a person. |
Provider Last Name Legal Name |
MCCRAY |
The last name of the provider. If the provider is an individual, this is the legal name. |
Provider First Name |
JOSHUA |
The first name of the provider, if the provider
is an individual. |
Provider Name Suffix Text |
JR. |
The name suffix of the provider if the provider
is an individual. The name suffix is a ‘‘generation-related’’ suffix, such as Jr., Sr., II, III, IV, or V. |
Provider First Line Business Practice Location Address |
3819 GULLIVER ST |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
LAS VEGAS |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
NV |
|
Provider Business Practice Location Address Postal Code |
891150358 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
5612155314 |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Fax Number |
7024326464 |
|
Provider Enumeration Date |
11/5/2013 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
11/5/2013 |
The date that a record was last updated or changed. |
Provider Gender Code |
M |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Taxonomy Code 1 |
225400000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Sole Proprietor |
Y |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |