Healthcare Provider Details

I. General information

NPI: 1114138013
Provider Name (Legal Business Name): DENISE KIM DRAKE N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3624 J DEWEY GRAY CIR STE 110
AUGUSTA GA
30909-6585
US

IV. Provider business mailing address

172 WOOD TRACE DR
WARRENVILLE SC
28951
US

V. Phone/Fax

Practice location:
  • Phone: 706-651-2667
  • Fax: 706-651-2670
Mailing address:
  • Phone: 803-663-4858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN185715
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: