Provider Demographics
NPI:1396715264
Name:CRAVENS, CHANDRA M (FNP)
Entity type:Individual
Prefix:MRS
First Name:CHANDRA
Middle Name:M
Last Name:CRAVENS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:CHANDRA
Other - Middle Name:BREN
Other - Last Name:MCCARTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 1345
Mailing Address - Street 2:
Mailing Address - City:LAMPASAS
Mailing Address - State:TX
Mailing Address - Zip Code:76550-0011
Mailing Address - Country:US
Mailing Address - Phone:281-989-3319
Mailing Address - Fax:888-616-0348
Practice Address - Street 1:111 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76501-7628
Practice Address - Country:US
Practice Address - Phone:512-639-1323
Practice Address - Fax:888-616-0348
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX658334363LF0000X, 363L00000X
CA589146363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
303152YT2MOtherMEDICARE PTAN:
TX092914303Medicaid