Healthcare Provider Details

I. General information

NPI: 1730541202
Provider Name (Legal Business Name): IESHA SCHANAE DRAPER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: IESHA SCHANAE CLAY

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 CROSSWINDS CT
WENTZVILLE MO
63385-4836
US

IV. Provider business mailing address

1800 COMMUNITY
CLINTON MO
64735-8804
US

V. Phone/Fax

Practice location:
  • Phone: 636-332-6000
  • Fax:
Mailing address:
  • Phone: 660-890-8156
  • Fax: 660-890-8156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2019024441
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: