Provider Demographics
NPI:1629700760
Name:DRAKE, KELLIE LYN (RN)
Entity Type:Individual
Prefix:MS
First Name:KELLIE
Middle Name:LYN
Last Name:DRAKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 SCOTTWOOD AVE APT B
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14903-1322
Mailing Address - Country:US
Mailing Address - Phone:607-857-0751
Mailing Address - Fax:
Practice Address - Street 1:100 ROBINWOOD AVE
Practice Address - Street 2:
Practice Address - City:ELMIRA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:14903-1549
Practice Address - Country:US
Practice Address - Phone:607-734-7132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY688839163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool