Provider Demographics
NPI:1003305137
Name:DRAKE, CAROL J (MSN, RN, APRN)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:DRAKE
Suffix:
Gender:F
Credentials:MSN, RN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 OLYMPIA DR STE 102A
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3673
Mailing Address - Country:US
Mailing Address - Phone:478-226-7578
Mailing Address - Fax:478-845-5258
Practice Address - Street 1:108 OLYMPIA DR STE 102A
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3673
Practice Address - Country:US
Practice Address - Phone:478-226-7578
Practice Address - Fax:478-845-5258
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN105510163WA2000X, 163WC0400X, 163WG0000X, 163WG0600X, 163WH0200X, 163WH1000X, 163WI0500X, 163WI0600X, 163WM0705X, 163WN0800X, 163WP2201X, 163WW0000X, 163WX0106X
GAR105510163WP2201X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WI0600XNursing Service ProvidersRegistered NurseInfection Control
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WN0800XNursing Service ProvidersRegistered NurseNeuroscience
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WX0106XNursing Service ProvidersRegistered NurseOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1003311580OtherNPPES
GAR105510OtherGA BOARD OF NURSING