Provider Demographics
NPI:1396569422
Name:DRAPER, AYDEN
Entity type:Individual
Prefix:
First Name:AYDEN
Middle Name:
Last Name:DRAPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 E CARRIAGE RD
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-8300
Mailing Address - Country:US
Mailing Address - Phone:801-529-5128
Mailing Address - Fax:
Practice Address - Street 1:2 E CARRIAGE RD
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-8300
Practice Address - Country:US
Practice Address - Phone:801-529-5128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator