Provider Demographics
NPI:1467475558
Name:DRAGER, HEATHER C (PA C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:C
Last Name:DRAGER
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LEE
Other - Last Name:CAPPS-DRAGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4425 JUAN TABO BLVD NE STE 112
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2684
Mailing Address - Country:US
Mailing Address - Phone:505-503-6800
Mailing Address - Fax:505-884-3004
Practice Address - Street 1:9201 MONTGOMERY BLVD NE STE 301
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2467
Practice Address - Country:US
Practice Address - Phone:505-717-1076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA053363A00000X
NMNM2001-PA21363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM67303030Medicaid
NM301565Medicare PIN
NM67303030Medicaid
P48013Medicare UPIN