Provider Demographics
NPI:1144268574
Name:DRAKE, JAMIE MICHELLE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:MICHELLE
Last Name:DRAKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:JAMIE
Other - Middle Name:MICHELLE
Other - Last Name:BARLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1593 E POLSTON AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-5326
Mailing Address - Country:US
Mailing Address - Phone:208-262-2300
Mailing Address - Fax:208-262-2390
Practice Address - Street 1:1551 E MULLAN AVE STE 100
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-9005
Practice Address - Country:US
Practice Address - Phone:208-262-2482
Practice Address - Fax:208-262-7460
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-2080363AS0400X, 363A00000X, 363AM0700X, 363AM0700X, 363AS0400X, 363A00000X
WAPA10004949363A00000X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1144268574Medicaid
ID1144268574Medicaid
WA8862126Medicare PIN