Provider Demographics
NPI:1083643274
Name:RAVENCRAFT, JAMES E II (PAC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:RAVENCRAFT
Suffix:II
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 WINCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7847
Mailing Address - Country:US
Mailing Address - Phone:606-325-9644
Mailing Address - Fax:
Practice Address - Street 1:2222 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7847
Practice Address - Country:US
Practice Address - Phone:606-325-9644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA336363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95003364Medicaid
KYP00847796OtherRAIL ROAD MEDICARE
KYP00847796OtherRAILROAD MEDICARE
KY970009625OtherRAILROAD MEDICARE
KY0403705Medicare PIN
KY970009625OtherRAILROAD MEDICARE
KYP00847796OtherRAILROAD MEDICARE
KY008580041Medicare PIN