Healthcare Provider Details

I. General information

NPI: 1013004498
Provider Name (Legal Business Name): RONALD TERRY DRAPER NP, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 WHITE SAGE AVE
DELTA UT
84624-8928
US

IV. Provider business mailing address

1055 N 500 W ATTN CREDENTIALING
PROVO UT
84604-3305
US

V. Phone/Fax

Practice location:
  • Phone: 435-864-3333
  • Fax: 435-864-2790
Mailing address:
  • Phone: 435-864-3333
  • Fax: 435-864-2790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number195011-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: