Provider Demographics
NPI:1487465571
Name:THOMAS, RAVEN (PA)
Entity type:Individual
Prefix:
First Name:RAVEN
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:6703 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PEWEE VALLEY
Mailing Address - State:KY
Mailing Address - Zip Code:40056-8031
Mailing Address - Country:US
Mailing Address - Phone:502-876-1598
Mailing Address - Fax:
Practice Address - Street 1:2125 STATE ST STE 3
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4972
Practice Address - Country:US
Practice Address - Phone:812-949-5575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant