Provider Demographics
NPI:1265321434
Name:DRAKE, GINGER (NNP)
Entity type:Individual
Prefix:MRS
First Name:GINGER
Middle Name:
Last Name:DRAKE
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 FAIRMONT DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-2587
Mailing Address - Country:US
Mailing Address - Phone:855-222-9637
Mailing Address - Fax:877-383-9267
Practice Address - Street 1:11 UPPER RIVERDALE ROAD
Practice Address - Street 2:11 UPPER RIVERDALE ROAD
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274
Practice Address - Country:US
Practice Address - Phone:470-856-2410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN213115363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care