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: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 S HIGHWAY 99
FILLMORE UT
84631-5033
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 435-253-8000
  • Fax: 435-655-5213
Mailing address:
  • Phone: 435-864-3333
  • Fax: 435-864-2790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number195011-4406
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number195011-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: