Provider Demographics
NPI:1295956621
Name:DRAKE, KENDIS MOORE (RN,NP)
Entity type:Individual
Prefix:
First Name:KENDIS
Middle Name:MOORE
Last Name:DRAKE
Suffix:
Gender:F
Credentials:RN,NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4490 N DROMEDARY RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2952
Mailing Address - Country:US
Mailing Address - Phone:602-952-9074
Mailing Address - Fax:602-840-9685
Practice Address - Street 1:1008 E MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2603
Practice Address - Country:US
Practice Address - Phone:602-393-0661
Practice Address - Fax:602-254-3474
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZRN038738363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health