Jenna Lynn Decraene, A.T.C., LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

36001248A Issued in IN

Practice address

7920 W Jefferson Blvd
Suite 100
Fort Wayne, IN 46804-4168

Phone

(260) 459-0917

NPI assigned

Apr 14, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661558400000",
    "number": "1902860141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "952 SKILLET AVE",
            "city": "HUNTERTOWN",
            "state": "IN",
            "postal_code": "467480109",
            "telephone_number": "260-515-0065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7920 W JEFFERSON BLVD",
            "address_2": "SUITE 100",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044168",
            "telephone_number": "260-459-0917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECRAENE",
        "first_name": "JENNA",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "A.T.C., LAT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-14",
        "last_updated": "2022-08-27",
        "certification_date": "2022-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IN",
            "license": "36001248A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "jdecraene@orthone.com",
            "affiliation": "N",
            "address_1": "7920 W Jefferson Blvd",
            "address_2": "Suite 100",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468044168",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Joellen Decamp
• Joseph Richard Decamp, MD
• Mackenzie Dechand, MA
• Kyle James Deck, LMHCA
• Shannon L Decker
• Bradley David Dedic, PHARMD
• Alyson Deel, MA
• Coral Deermer, RBT
• Erica Deetz
• Susan Rebekah Defrain, NP-C

• All providers in Fort Wayne, IN
• Athletic Trainer in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.