Individual
KELLY DRAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2730 W AGUA FRIA FWY, STE 100, PHOENIX, AZ 85027-7201
(623) 537-5600
Mailing address
3010 W AGUA FRIA FWY STE 100, PHOENIX, AZ 85027-3944
(623) 537-5600
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
12203277-1206
UT
363A00000X
Physician Assistant
Primary
4318
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
379670
—
AZ
Enumeration date
09/15/2008
Last updated
03/22/2023
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