Raven Thacker, NP
Nurse Practitioner, Acute Care in Houston, TX. Individual provider (NPI-1).
NPI number1003673559
StatusActive
Last updated in NPPESApr 30, 2024
Details
- NPI
- 1003673559
- Entity type
- Individual (NPI-1)
- Name
- Raven Thacker
- Credential
- NP
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Mar 1, 2024
- Certification date
- Apr 30, 2024
- Last updated
- Apr 30, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LA2100X | Nurse Practitioner, Acute Care | 1136389 | TX | Yes |
| 363LG0600X | Nurse Practitioner, Gerontology | 1136389 | TX |
Practice location
1515 Holcombe BlvdHouston, TX 77030-4000
Phone 713-792-6161
Mailing address
P O Box 4439Houston, TX 77210-4439
Phone 713-792-2991
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