Provider Demographics
NPI:1316495187
Name:CRAVEN, ATHENA KARIN (PA)
Entity type:Individual
Prefix:
First Name:ATHENA
Middle Name:KARIN
Last Name:CRAVEN
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:ATHENA
Other - Middle Name:KARIN
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:4520 N MACARTHUR BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-1235
Mailing Address - Country:US
Mailing Address - Phone:214-630-5256
Mailing Address - Fax:
Practice Address - Street 1:4520 N MACARTHUR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-1235
Practice Address - Country:US
Practice Address - Phone:214-630-5256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA18446363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant