Provider Demographics
NPI:1518255322
Name:DRAKE, JOULVOUS VENCIN (NP-C)
Entity Type:Individual
Prefix:
First Name:JOULVOUS
Middle Name:VENCIN
Last Name:DRAKE
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:JARVIS
Other - Middle Name:VENCIN
Other - Last Name:DRAKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP-C
Mailing Address - Street 1:PO BOX 2267
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-9267
Mailing Address - Country:US
Mailing Address - Phone:832-519-9339
Mailing Address - Fax:346-388-3014
Practice Address - Street 1:1935 TEXAS PKWY
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-3121
Practice Address - Country:US
Practice Address - Phone:832-519-9339
Practice Address - Fax:346-388-3014
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX804376163W00000X
TXAP145022363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse