Provider Demographics
NPI:1316743321
Name:MULLEN, RAVEN MARIE
Entity type:Individual
Prefix:
First Name:RAVEN
Middle Name:MARIE
Last Name:MULLEN
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 1:5000 BACK SQUARE DR STE D
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-7411
Mailing Address - Country:US
Mailing Address - Phone:270-685-5500
Mailing Address - Fax:270-685-5565
Practice Address - Street 1:5000 BACK SQUARE DR STE D
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-7411
Practice Address - Country:US
Practice Address - Phone:270-685-5500
Practice Address - Fax:270-685-5565
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator