Healthcare Provider Details

I. General information

NPI: 1861780660
Provider Name (Legal Business Name): KELLIE DRAPEAU PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLIE ANDREWS

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S BROADWAY AVE
SALEM OH
44460-3002
US

IV. Provider business mailing address

130 S BROADWAY AVE
SALEM OH
44460-3002
US

V. Phone/Fax

Practice location:
  • Phone: 220-270-6090
  • Fax: 570-755-6627
Mailing address:
  • Phone:
  • Fax: 570-755-6627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: