Provider Demographics
NPI:1699479337
Name:DRAKE, LOUISE LAVETT
Entity type:Individual
Prefix:MRS
First Name:LOUISE
Middle Name:LAVETT
Last Name:DRAKE
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 1:305 CIMARRON TRL # 190
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-4508
Mailing Address - Country:US
Mailing Address - Phone:443-636-0595
Mailing Address - Fax:
Practice Address - Street 1:305 CIMARRON TRAIL 190
Practice Address - Street 2:SUITE 9
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063
Practice Address - Country:US
Practice Address - Phone:667-298-8921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1744P3200X
TX1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management