Provider Demographics
NPI:1831127406
Name:DRAEGER, ELESHA B (NP)
Entity Type:Individual
Prefix:
First Name:ELESHA
Middle Name:B
Last Name:DRAEGER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1513
Mailing Address - Country:US
Mailing Address - Phone:417-627-8967
Mailing Address - Fax:417-627-8920
Practice Address - Street 1:203 W MAIN ST # PO403
Practice Address - Street 2:
Practice Address - City:CHERRYVALE
Practice Address - State:KS
Practice Address - Zip Code:67335
Practice Address - Country:US
Practice Address - Phone:620-336-2131
Practice Address - Fax:620-336-3149
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS46141363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200354220CMedicaid
MO427487707Medicaid