Provider Demographics
NPI:1881283034
Name:RAVEN, KAYLEE KRISTEN
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:KRISTEN
Last Name:RAVEN
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 1:910 W 25TH ST APT 605
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-4451
Mailing Address - Country:US
Mailing Address - Phone:361-571-8918
Mailing Address - Fax:
Practice Address - Street 1:2000 RANCH ROAD 620 S
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-6411
Practice Address - Country:US
Practice Address - Phone:512-599-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician