Individual
KELLY DRAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
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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