Provider Demographics
NPI:1114138013
Name:DRAKE, DENISE KIM (NP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:KIM
Last Name:DRAKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 WOOD TRACE DR
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:28951
Mailing Address - Country:US
Mailing Address - Phone:803-663-4858
Mailing Address - Fax:
Practice Address - Street 1:3624 J DEWEY GRAY CIR STE 110
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6585
Practice Address - Country:US
Practice Address - Phone:706-651-2667
Practice Address - Fax:706-651-2670
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN185715363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner