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General NPI Number Information
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NPI Number | 1114599370
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Entity Type | Individual
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Provider Name | JORDYN AUDREY DRAKE DO
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Gender | Female
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Dates
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Enumeration Date | 07/15/2021
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 559 VINCENT ST SPC BASE
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City | PETERSON AFB
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State | CO
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Zip | 80914-1541
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Country | US
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Telephone | 719-567-5536
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Fax |
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Provider Business Mailing Address
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Address Line | 559 VINCENT ST SPC BASE
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City | PETERSON AFB
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State | CO
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Zip | 80914-1541
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Country | US
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Telephone | 719-567-5536
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036171403
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 125077767
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License Number State | IL
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