Healthcare Provider Details
I. General information
NPI: 1003305137
Provider Name (Legal Business Name): CAROL J. DRAKE MSN, RN, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 05/03/2018
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
108 OLYMPIA DR STE 102A
WARNER ROBINS GA
31093-3673
US
IV. Provider business mailing address
108 OLYMPIA DR STE 102A
WARNER ROBINS GA
31093-3673
US
V. Phone/Fax
- Phone: 478-226-7578
- Fax: 478-845-5258
- Phone: 478-226-7578
- Fax: 478-845-5258
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WA2000X |
| Taxonomy | Administrator Registered Nurse |
| License Number | RN105510 |
| License Number State | GA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC0400X |
| Taxonomy | Case Management Registered Nurse |
| License Number | RN105510 |
| License Number State | GA |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WG0000X |
| Taxonomy | General Practice Registered Nurse |
| License Number | RN105510 |
| License Number State | GA |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WG0600X |
| Taxonomy | Gerontology Registered Nurse |
| License Number | RN105510 |
| License Number State | GA |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WH0200X |
| Taxonomy | Home Health Registered Nurse |
| License Number | RN105510 |
| License Number State | GA |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WH1000X |
| Taxonomy | Hospice Registered Nurse |
| License Number | RN105510 |
| License Number State | GA |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WI0500X |
| Taxonomy | Infusion Therapy Registered Nurse |
| License Number | RN105510 |
| License Number State | GA |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WI0600X |
| Taxonomy | Infection Control Registered Nurse |
| License Number | RN105510 |
| License Number State | GA |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WM0705X |
| Taxonomy | Medical-Surgical Registered Nurse |
| License Number | RN105510 |
| License Number State | GA |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WN0800X |
| Taxonomy | Neuroscience Registered Nurse |
| License Number | RN105510 |
| License Number State | GA |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP2201X |
| Taxonomy | Ambulatory Care Registered Nurse |
| License Number | RN105510 |
| License Number State | GA |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP2201X |
| Taxonomy | Ambulatory Care Registered Nurse |
| License Number | R105510 |
| License Number State | GA |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WW0000X |
| Taxonomy | Wound Care Registered Nurse |
| License Number | RN105510 |
| License Number State | GA |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WX0106X |
| Taxonomy | Occupational Health Registered Nurse |
| License Number | RN105510 |
| License Number State | GA |
| # 15 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 163W00000X |
| Taxonomy | Registered Nurse |
| License Number | R105510 |
| License Number State | GA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
