Healthcare Provider Details

I. General information

NPI: 1831127406
Provider Name (Legal Business Name): ELESHA B DRAEGER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 W MAIN ST # PO403
CHERRYVALE KS
67335
US

IV. Provider business mailing address

1701 W 26TH ST
JOPLIN MO
64804-1513
US

V. Phone/Fax

Practice location:
  • Phone: 620-336-2131
  • Fax: 620-336-3149
Mailing address:
  • Phone: 417-627-8967
  • Fax: 417-627-8920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number46141
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: