Provider Demographics
NPI:1164471926
Name:DRAWDY, JOSEPH D (APRN)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:D
Last Name:DRAWDY
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 MICBETH DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:KY
Mailing Address - Zip Code:42445-6332
Mailing Address - Country:US
Mailing Address - Phone:270-365-1225
Mailing Address - Fax:270-365-1252
Practice Address - Street 1:117 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:KY
Practice Address - Zip Code:42078-9998
Practice Address - Country:US
Practice Address - Phone:270-988-3839
Practice Address - Fax:270-988-3832
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0242744-23163WG0600X
KY3002206363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78001674Medicaid
KY0391304OtherPERSONAL MEDICARE
KYS21815Medicare UPIN
KY0391304OtherPERSONAL MEDICARE
KY0391304OtherPERSONAL MEDICARE