Healthcare Provider Details

I. General information

NPI: 1417404856
Provider Name (Legal Business Name): PATTY DRAKE RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5068 W PLANO PKWY SUITE 366
PLANO TX
75093-4408
US

IV. Provider business mailing address

PO BOX 261612
PLANO TX
75026-1612
US

V. Phone/Fax

Practice location:
  • Phone: 469-988-8264
  • Fax: 972-767-3545
Mailing address:
  • Phone: 469-988-8264
  • Fax: 972-767-3545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number509519
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: