Provider Demographics
NPI:1134779747
Name:CRAVEN, KELLI ANN (NP)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:ANN
Last Name:CRAVEN
Suffix:
Gender:F
Credentials:NP
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 341
Mailing Address - Street 2:
Mailing Address - City:WANBLEE
Mailing Address - State:SD
Mailing Address - Zip Code:57577-0341
Mailing Address - Country:US
Mailing Address - Phone:713-703-6989
Mailing Address - Fax:
Practice Address - Street 1:100 HEALTHY WAY
Practice Address - Street 2:
Practice Address - City:OLIVIA
Practice Address - State:MN
Practice Address - Zip Code:56277-1117
Practice Address - Country:US
Practice Address - Phone:320-523-3483
Practice Address - Fax:320-523-3430
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142533207Q00000X
ID2261377363LF0000X
MI4704406162363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily