Healthcare Provider Details

I. General information

NPI: 1295956621
Provider Name (Legal Business Name): KENDIS MOORE DRAKE RN,NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 E MCDOWELL RD
PHOENIX AZ
85006-2603
US

IV. Provider business mailing address

4490 N DROMEDARY RD
PHOENIX AZ
85018-2952
US

V. Phone/Fax

Practice location:
  • Phone: 602-393-0661
  • Fax: 602-254-3474
Mailing address:
  • Phone: 602-952-9074
  • Fax: 602-840-9685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN038738
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: