Provider Demographics
NPI:1689650863
Name:HALCOMB, RAGHEDA (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:RAGHEDA
Middle Name:
Last Name:HALCOMB
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 261160
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75026-1160
Mailing Address - Country:US
Mailing Address - Phone:972-772-4539
Mailing Address - Fax:972-772-8099
Practice Address - Street 1:3501 TWIN LAKES WAY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7556
Practice Address - Country:US
Practice Address - Phone:972-378-3181
Practice Address - Fax:972-403-5444
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29453367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX088730903Medicaid
TX87614UOtherBCBS
TX8J4566Medicare PIN
TX88303HMedicare ID - Type Unspecified606K
S27737Medicare UPIN