Basic Information
| Provider Information | |||||||||
| NPI: | 1174504484 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DRAKE | ||||||||
| FirstName: | KATIE | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6703 38TH AVE N | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337101536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7272132377 | ||||||||
| FaxNumber: | 7278289639 | ||||||||
| Practice Location | |||||||||
| Address1: | 6703 38TH AVE N | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337101536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7272132377 | ||||||||
| FaxNumber: | 7278289639 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2005 | ||||||||
| LastUpdateDate: | 09/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS9565 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 016080000 | 05 | FL | MEDICAID | 000013683G | 01 | FL | HUMANA | OTHER | 16304 | 01 | FL | BC/BS OF FLORIDA | OTHER | 389141 | 01 | FL | AVMED | OTHER |