Provider Demographics
NPI:1497855399
Name:MCRAVEN, JANICE (ANP)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:MCRAVEN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 W MARKHAM ST
Mailing Address - Street 2:UAMS #783
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-686-8000
Mailing Address - Fax:501-526-6562
Practice Address - Street 1:4301 W MARKHAM ST
Practice Address - Street 2:UAMS #783
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-686-8000
Practice Address - Fax:501-526-6562
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01297363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA01297OtherTRICARE
ARP00375104OtherRAILROAD MEDICARE
AR5A266Medicare ID - Type Unspecified
ARA01297OtherTRICARE