Provider Demographics
NPI:1003986696
Name:DRAPER, CATHRYN DIANN (ARNP)
Entity Type:Individual
Prefix:
First Name:CATHRYN
Middle Name:DIANN
Last Name:DRAPER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 MEDICAL CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4314
Mailing Address - Country:US
Mailing Address - Phone:541-930-7260
Mailing Address - Fax:541-930-7220
Practice Address - Street 1:520 SW RAMSEY AVE STE 204
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5535
Practice Address - Country:US
Practice Address - Phone:541-930-7223
Practice Address - Fax:541-930-7221
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3708363LA2200X
OR201907305NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9647686Medicaid