Provider Demographics
NPI:1518950195
Name:DRAKE, BELINDA T (NP)
Entity Type:Individual
Prefix:
First Name:BELINDA
Middle Name:T
Last Name:DRAKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10880
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-0880
Mailing Address - Country:US
Mailing Address - Phone:928-759-5874
Mailing Address - Fax:928-458-2039
Practice Address - Street 1:474 N HIGHWAY 89
Practice Address - Street 2:
Practice Address - City:CHINO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86323-5993
Practice Address - Country:US
Practice Address - Phone:928-636-5680
Practice Address - Fax:928-636-5853
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13051363LF0000X
AZAP1374363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAP1374OtherARIZONA STATE BOARD OF NURSING
AZ710881Medicaid
AZ710881Medicaid