Provider Demographics
NPI:1316654767
Name:SCHICHTL, DRAKE
Entity type:Individual
Prefix:
First Name:DRAKE
Middle Name:
Last Name:SCHICHTL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 DANIEL DR
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72927-4055
Mailing Address - Country:US
Mailing Address - Phone:479-675-2455
Mailing Address - Fax:479-675-4940
Practice Address - Street 1:128 DANIEL DR
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72927-4055
Practice Address - Country:US
Practice Address - Phone:479-675-2455
Practice Address - Fax:479-675-4940
Is Sole Proprietor?:No
Enumeration Date:2022-11-03
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR220818363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily