Provider Demographics
NPI:1942487079
Name:DRAKE, KELLY LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:LYNN
Last Name:DRAKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JHMI - DIVISION OF CHILD AND ADOLESCENT PSYCHIATRY
Mailing Address - Street 2:600 N. WOLFE ST., CMSC 374
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0001
Mailing Address - Country:US
Mailing Address - Phone:410-955-7674
Mailing Address - Fax:410-502-0521
Practice Address - Street 1:JHMI - DIVISION OF CHILD AND ADOLESCENT PSYCHIATRY
Practice Address - Street 2:600 N. WOLFE ST., CMSC 374
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0001
Practice Address - Country:US
Practice Address - Phone:410-955-7674
Practice Address - Fax:410-502-0521
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program