Active NPI
Justin Lee Drake, BS.MS.ATC.LAT
- Athletic Trainer
- Rolla, MO
National Provider Identifier
1891814091
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT3725
- Practice address
- 705 W 10TH St
Rolla, MO 65409-6520 - Phone
- (936) 552-1714
- NPI assigned
- Mar 28, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT3725 | TX | Primary |
Addresses
Primary practice location
705 W 10TH St
Rolla, MO 65409-6520
Mailing address
PO Box 632
Saint Robert, MO 65584-0632
Phone (936) 552-1714
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT3725 | TX | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1239753600000",
"number": "1891814091",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 632",
"city": "SAINT ROBERT",
"state": "MO",
"postal_code": "655840632",
"telephone_number": "936-552-1714"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "705 W 10TH ST",
"city": "ROLLA",
"state": "MO",
"postal_code": "654096520",
"telephone_number": "936-552-1714"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DRAKE",
"first_name": "JUSTIN",
"middle_name": "LEE",
"name_prefix": "Mr.",
"credential": "BS.MS.ATC.LAT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-28",
"last_updated": "2009-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TX",
"license": "AT3725",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rolla, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.