Individual provider Active NPI

Mary-Jo Drake, CRNA

  • Certified Registered Nurse Anesthetist
  • Dickson, TN
National Provider Identifier
1558320655
Registry record updated Oct 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
APN13743 Issued in TN
Practice address
704 Hwy 70 E
Dickson, TN 37055-2111
Phone
(615) 441-4504
Fax
(615) 620-2323
NPI assigned
Mar 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2010

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 002039 CT
Certified Registered Nurse Anesthetist 367500000X APN13743 TN Primary
Registered Nurse 163W00000X RN167485 TN

Addresses

Primary practice location

704 Hwy 70 E
Dickson, TN 37055-2111

Mailing address

PO Box 291264
Nashville, TN 37229-1264
Phone (615) 620-2330

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
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
5408TNMDProfessional Counselor
002039CTMDClinical Psychologist
RN167485TNMDRegistered Nurse
APN13743TNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Integrated Anesthesia Services, PLC Nurse Anesthetist, Certified Registered Past Accepting new patients
Neurosurgical Anesthesiologist,PLC Past Accepting new patients
Woodland Anesthesia Associates PC Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1142812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1286496000000",
    "number": "1558320655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 291264",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372291264",
            "telephone_number": "615-620-2330",
            "fax_number": "615-620-2323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 HWY 70 E",
            "city": "DICKSON",
            "state": "TN",
            "postal_code": "370552111",
            "telephone_number": "615-441-4504",
            "fax_number": "615-620-2323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DRAKE",
        "first_name": "MARY-JO",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-20",
        "last_updated": "2010-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "CT",
            "license": "002039",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "APN13743",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TN",
            "license": "RN167485",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dickson, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2010; 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.