Provider Demographics
NPI:1568043081
Name:DRAKE, STACIE C (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:C
Last Name:DRAKE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 THRUSHGILL LN APT 10203
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6647
Mailing Address - Country:US
Mailing Address - Phone:931-698-2718
Mailing Address - Fax:
Practice Address - Street 1:10000 THRUSHGILL LN APT 10203
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6647
Practice Address - Country:US
Practice Address - Phone:931-698-2718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29481363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health