Provider Demographics
NPI:1538131008
Name:DRAKE, KIRSTEN A (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KIRSTEN
Middle Name:A
Last Name:DRAKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 HIGHLAND BLVD
Mailing Address - Street 2:HIGHLAND PARK 4-PERIOPERATIVE
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6902
Mailing Address - Country:US
Mailing Address - Phone:406-585-1018
Mailing Address - Fax:406-585-1026
Practice Address - Street 1:905 HIGHLAND BLVD STE 4500
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6903
Practice Address - Country:US
Practice Address - Phone:406-414-5150
Practice Address - Fax:406-414-5175
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT431363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1538131008Medicaid
MT000096723OtherBLUE CROSS BLUE SHIELD
000084986Medicare PIN
MTQ55358Medicare UPIN