Provider Demographics
NPI:1992206288
Name:DRAYDEN, KEAIRA KEONTE (RN)
Entity type:Individual
Prefix:
First Name:KEAIRA
Middle Name:KEONTE
Last Name:DRAYDEN
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 1:1302 CORNELL ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-3534
Mailing Address - Country:US
Mailing Address - Phone:903-331-2078
Mailing Address - Fax:
Practice Address - Street 1:1302 CORNELL ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-3534
Practice Address - Country:US
Practice Address - Phone:903-331-2078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX338219164X00000X
171M00000X
TX982300163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator