Provider Demographics
NPI:1134441587
Name:FLAKE, ERICA DALE (FPMHNP-BC)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:DALE
Last Name:FLAKE
Suffix:
Gender:F
Credentials:FPMHNP-BC
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 681029
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-1029
Mailing Address - Country:US
Mailing Address - Phone:855-560-4999
Mailing Address - Fax:
Practice Address - Street 1:129 N LOCUST AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-3757
Practice Address - Country:US
Practice Address - Phone:855-560-4999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006816363LP0808X
MSR862249363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09556847Medicaid
MS302I504220Medicare UPIN