Provider Demographics
NPI:1013004498
Name:DRAPER, RONALD TERRY (NP, CRNA)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:TERRY
Last Name:DRAPER
Suffix:
Gender:M
Credentials:NP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:ATTN CREDENTIALING
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:435-864-3333
Mailing Address - Fax:435-864-2790
Practice Address - Street 1:770 S HIGHWAY 99
Practice Address - Street 2:
Practice Address - City:FILLMORE
Practice Address - State:UT
Practice Address - Zip Code:84631-5033
Practice Address - Country:US
Practice Address - Phone:435-253-8000
Practice Address - Fax:435-655-5213
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT195011-4406367500000X
UT195011-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT942854057540Medicaid