Provider Demographics
NPI:1497395008
Name:DRAKE, KEITH DEAN (NREMT-PARAMEDIC)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:DEAN
Last Name:DRAKE
Suffix:
Gender:M
Credentials:NREMT-PARAMEDIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12609 JAVEA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-1541
Mailing Address - Country:US
Mailing Address - Phone:737-400-1009
Mailing Address - Fax:
Practice Address - Street 1:12609 JAVEA DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78739-1541
Practice Address - Country:US
Practice Address - Phone:737-400-1009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-11
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0947383146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic