Provider Demographics
NPI:1861825929
Name:RAVEN CORPORATION OF NEW ORLEANS
Entity Type:Organization
Organization Name:RAVEN CORPORATION OF NEW ORLEANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:JEMISON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:504-459-2430
Mailing Address - Street 1:8030 CROWDER BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-1076
Mailing Address - Country:US
Mailing Address - Phone:504-459-2430
Mailing Address - Fax:504-226-0532
Practice Address - Street 1:8030 CROWDER BLVD STE B
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-1076
Practice Address - Country:US
Practice Address - Phone:504-459-2430
Practice Address - Fax:504-226-0532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363LF0000X
LAAP07502364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty