Provider Demographics
NPI:1518592534
Name:ARAVIND, RAVEN (AG-ACNP)
Entity Type:Individual
Prefix:
First Name:RAVEN
Middle Name:
Last Name:ARAVIND
Suffix:
Gender:F
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 CADDO STREET
Mailing Address - Street 2:NUMBER 4
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-4223
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1900 CADDO STREET
Practice Address - Street 2:NUMBER 4
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-4223
Practice Address - Country:US
Practice Address - Phone:817-266-5142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144708363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care