Provider Demographics
NPI:1649299348
Name:CRAVENS, THOMAS (CRNA)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:CRAVENS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7550 PYRAMID PEAK LN
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8386
Mailing Address - Country:US
Mailing Address - Phone:314-910-1738
Mailing Address - Fax:
Practice Address - Street 1:2560 SAMARITAN DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1170
Practice Address - Country:US
Practice Address - Phone:800-421-8274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113575367500000X
NMCRNA00749367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILENROLLEDMedicaid
NM39700755Medicaid
MO600420002Medicaid
IL$$$$$$$$$001Medicaid