Healthcare Provider Details

I. General information

NPI: 1437069135
Provider Name (Legal Business Name): BREANNA DRAKE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 E COLUMBIA AVE
LEESVILLE SC
29070-7318
US

IV. Provider business mailing address

7750 TWO NOTCH RD
BATESBURG SC
29006-9732
US

V. Phone/Fax

Practice location:
  • Phone: 803-532-8155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number32733
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: