Healthcare Provider Details

I. General information

NPI: 1710305560
Provider Name (Legal Business Name): AUDREY DEEKEN DRAISEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AUDREY DEEKEN MD

II. Dates (important events)

Enumeration Date: 03/30/2014
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9705 LENEXA DR
LENEXA KS
66215-1345
US

IV. Provider business mailing address

9705 LENEXA DR
LENEXA KS
66215-1345
US

V. Phone/Fax

Practice location:
  • Phone: 913-396-8509
  • Fax: 913-318-8378
Mailing address:
  • Phone: 913-396-8509
  • Fax: 913-318-8378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2022029082
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number04-46675
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number036144258
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: