Provider Demographics
NPI:1194315739
Name:DRAEHN, TARA (FNP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:DRAEHN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9851 FM 1097 RD W STE 120
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77318-5852
Mailing Address - Country:US
Mailing Address - Phone:936-890-8000
Mailing Address - Fax:833-973-0788
Practice Address - Street 1:9851 FM 1097 RD W STE 120
Practice Address - Street 2:
Practice Address - City:WILLIS
Practice Address - State:TX
Practice Address - Zip Code:77318-5852
Practice Address - Country:US
Practice Address - Phone:936-890-8000
Practice Address - Fax:833-973-0788
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1027209363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily