Provider Demographics
NPI:1487390126
Name:MCKOY DRAKE, LILY CAITLIN (D0, MPH)
Entity type:Individual
Prefix:DR
First Name:LILY
Middle Name:CAITLIN
Last Name:MCKOY DRAKE
Suffix:
Gender:F
Credentials:D0, MPH
Other - Prefix:
Other - First Name:LILY
Other - Middle Name:CAITLIN
Other - Last Name:MCKOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:MSC09 5040
Mailing Address - Street 2:1 UNIVERSITY OF NEW MEXICO
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:81731
Mailing Address - Country:US
Mailing Address - Phone:505-272-6607
Mailing Address - Fax:505-272-8045
Practice Address - Street 1:MSC09 5040
Practice Address - Street 2:1 UNIVERSITY OF NEW MEXICO
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:81731
Practice Address - Country:US
Practice Address - Phone:505-272-6607
Practice Address - Fax:505-272-8045
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program