Provider Demographics
NPI:1972629269
Name:CRAVENS, KARRIE ANN (NP)
Entity type:Individual
Prefix:
First Name:KARRIE
Middle Name:ANN
Last Name:CRAVENS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4980 N CAMINO ANTONIO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-6006
Mailing Address - Country:US
Mailing Address - Phone:520-628-7871
Mailing Address - Fax:520-205-8461
Practice Address - Street 1:140 W SPEEDWAY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-7687
Practice Address - Country:US
Practice Address - Phone:520-628-7871
Practice Address - Fax:520-205-8461
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN050573363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ961707Medicaid