Provider Demographics
NPI:1639970783
Name:FREEMAN, RAVENSYMONE
Entity type:Individual
Prefix:
First Name:RAVENSYMONE
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4619 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-5224
Mailing Address - Country:US
Mailing Address - Phone:501-449-1588
Mailing Address - Fax:501-449-1588
Practice Address - Street 1:4619 W 25TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-5224
Practice Address - Country:US
Practice Address - Phone:501-298-0491
Practice Address - Fax:501-298-0491
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR940260790172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver