Provider Demographics
NPI:1457118739
Name:JONES, RAVEN NICHOLE
Entity type:Individual
Prefix:
First Name:RAVEN
Middle Name:NICHOLE
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1438 BANBURY CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77073-4532
Mailing Address - Country:US
Mailing Address - Phone:818-384-9037
Mailing Address - Fax:
Practice Address - Street 1:1438 BANBURY CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77073-4532
Practice Address - Country:US
Practice Address - Phone:818-384-9037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor