Provider Demographics
NPI:1083227870
Name:PIRTLE, RAVEN NICOLE (APRN)
Entity type:Individual
Prefix:
First Name:RAVEN
Middle Name:NICOLE
Last Name:PIRTLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 BELLEMEADE AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-1775
Mailing Address - Country:US
Mailing Address - Phone:812-426-6152
Mailing Address - Fax:812-426-6160
Practice Address - Street 1:265 BELLEMEADE AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1775
Practice Address - Country:US
Practice Address - Phone:812-426-6152
Practice Address - Fax:812-426-6160
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2025-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY57798363LF0000X
IN71016176A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily