Healthcare Provider Details

I. General information

NPI: 1770405896
Provider Name (Legal Business Name): JENNA DRAKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 NALL AVE
PRAIRIE VILLAGE KS
66208-2453
US

IV. Provider business mailing address

708 SE BLUE BIRD
BLUE SPRINGS MO
64014-2110
US

V. Phone/Fax

Practice location:
  • Phone: 913-335-0428
  • Fax: 913-273-2572
Mailing address:
  • Phone: 913-335-0428
  • Fax: 913-273-2572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2026035990
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: