Provider Demographics
NPI:1952993354
Name:BRAKE, ELIZEBETH ANN (PMHNP)
Entity type:Individual
Prefix:
First Name:ELIZEBETH
Middle Name:ANN
Last Name:BRAKE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 STATE ROUTE T
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-7437
Mailing Address - Country:US
Mailing Address - Phone:417-204-2284
Mailing Address - Fax:
Practice Address - Street 1:137 BLUFF ST
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-7651
Practice Address - Country:US
Practice Address - Phone:515-441-7944
Practice Address - Fax:515-441-7944
Is Sole Proprietor?:No
Enumeration Date:2021-02-07
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021004603363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health