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Melanie Jo Drake, MD PLLC

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Company Details

Name: Melanie Jo Drake, MD PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 03 Jan 2023 (3 years ago)
Financial Date End: 31 Jan 2026
Entity Number: 5046370
Place of Formation: IDAHO
File Number: 856342
ZIP code: 83705
County: Ada County
Principal Address: 1525 S OWYHEE ST BOISE, ID 83705
Mailing Address: 1116 S VISTA AVE PMB 235 BOISE, ID 83705-2429

Manager

Name Role Address Appointed On
Melanie Jo Drake MD Manager 1525 S OWYHEE ST, BOISE, ID 83705 2024-01-29

Agent

Name Role Address
Melanie J Drake Agent 3350 W AMERICANA TERRACE, STE 360-C, BOISE, ID 83706

National Provider Identifier

NPI Number:
1194550111
Certification Date:
2024-09-08

Authorized Person:

Name:
MELANIE JO DRAKE
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
2084P0800X - Psychiatry Physician
Is Primary:
Yes

Contacts:

Fax:
2082058031

Filing

Filing Name Filing Number Filing date
Annual Report 0006044915 2025-01-03
Change of Registered Office/Agent/Both (by Entity) 0005754268 2024-06-03
Statement of Change of Business Mailing Address 0005754117 2024-06-03
Annual Report 0005573454 2024-01-29
Statement of Change of Business Mailing Address 0005368104 2023-08-21

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Date of last update: 19 Jun 2025

Sources: Idaho Secretary of State