Provider Demographics
NPI:1235753351
Name:HOUSTON, RAVEN (PA-C)
Entity Type:Individual
Prefix:
First Name:RAVEN
Middle Name:
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 FANNIN ST STE 2350
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1554
Mailing Address - Country:US
Mailing Address - Phone:713-486-6755
Mailing Address - Fax:713-383-1478
Practice Address - Street 1:6400 FANNIN ST STE 2350
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1554
Practice Address - Country:US
Practice Address - Phone:713-486-6755
Practice Address - Fax:713-383-1478
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA13849363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant