Provider Demographics
NPI:1275194441
Name:RAKES, LINDA MICHELLE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:MICHELLE
Last Name:RAKES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BEECHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BASSETT
Mailing Address - State:VA
Mailing Address - Zip Code:24055-4143
Mailing Address - Country:US
Mailing Address - Phone:276-252-6463
Mailing Address - Fax:
Practice Address - Street 1:312 FAIRY STREET EXT STE 101
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-1912
Practice Address - Country:US
Practice Address - Phone:276-403-4278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011934207Q00000X
VA0024178168207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine