Healthcare Provider Details

I. General information

NPI: 1861103871
Provider Name (Legal Business Name): LEANNA DRAKE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 S MAIN ST
CAMP VERDE AZ
86322-7155
US

IV. Provider business mailing address

348 S MAIN ST
CAMP VERDE AZ
86322-7155
US

V. Phone/Fax

Practice location:
  • Phone: 928-649-6477
  • Fax: 928-345-0445
Mailing address:
  • Phone: 928-649-6477
  • Fax: 928-345-0445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number284734
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: