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General NPI Number Information
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NPI Number | 1013514454
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Entity Type | Individual
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Provider Name | STEPHANIE CAUDLE DRAKER NP-C
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Gender | Female
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Dates
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Enumeration Date | 10/08/2020
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 6915 VILLAGE MEDICAL CIR
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City | CLEMMONS
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State | NC
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Zip | 27012-8002
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Country | US
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Telephone | 336-718-1680
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Fax | 336-718-1681
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Provider Business Mailing Address
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Address Line | PO BOX 751803
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City | CHARLOTTE
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State | NC
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Zip | 28275-1803
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Country | US
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Telephone | 336-718-7680
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Fax | 336-718-1681
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5013645
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5013645
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License Number State | NC
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