Individual provider Active NPI

Jacqueline Yvonne Draper, MD

  • Anesthesiology Physician
  • Memphis, TN
National Provider Identifier
1053486233
Registry record updated Jan 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
MD028347 Issued in TN
Practice address
1068 Cresthaven Rd
Suite 150
Memphis, TN 38119-0800
Phone
(901) 682-6828
NPI assigned
Nov 22, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X MD028347 TN Primary

Addresses

Primary practice location

1068 Cresthaven Rd
Suite 150
Memphis, TN 38119-0800

Mailing address

1068 Cresthaven Rd Ste 150
Memphis, TN 38119-3859
Phone (901) 682-6828

Other identifiers 2

IdentifierTypeStateIssuer
3804836MedicaidTN
4014612OtherBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD028347TNMDAnesthesiology Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422489600000",
    "number": "1053486233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1068 CRESTHAVEN RD STE 150",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381193859",
            "telephone_number": "901-682-6828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1068 CRESTHAVEN RD",
            "address_2": "SUITE 150",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381190800",
            "telephone_number": "901-682-6828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DRAPER",
        "first_name": "JACQUELINE",
        "middle_name": "YVONNE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-22",
        "last_updated": "2015-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "TN",
            "license": "MD028347",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3804836",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "4014612",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.