=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891388856
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEEGAN MICHAEL DRAWE APRN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2021
-----------------------------------------------------
Last Update Date | 09/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5300 S HIGHWAY 95 STE A
-----------------------------------------------------
City | FORT MOHAVE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86426-9251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-788-1911
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 32236
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89173-2236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-735-4568
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 840039
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 230897
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------