Provider Demographics
NPI:1649247578
Name:DRAPER, CHERYL A (PA-C)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:DRAPER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 3RD AVE SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1010
Mailing Address - Country:US
Mailing Address - Phone:360-754-3934
Mailing Address - Fax:360-412-8954
Practice Address - Street 1:4525 3RD AVE SE
Practice Address - Street 2:SUITE 200
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1010
Practice Address - Country:US
Practice Address - Phone:360-754-3934
Practice Address - Fax:360-412-8954
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003816363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8450421Medicaid
WA8450421Medicaid
WA8859352Medicare ID - Type Unspecified