Basic Information
| Provider Information | |||||||||
| NPI: | 1134779747 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRAVEN | ||||||||
| FirstName: | KELLI | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 341 | ||||||||
| Address2: | |||||||||
| City: | WANBLEE | ||||||||
| State: | SD | ||||||||
| PostalCode: | 575770341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137036989 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 HEALTHY WAY | ||||||||
| Address2: | |||||||||
| City: | OLIVIA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 562771117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3205233483 | ||||||||
| FaxNumber: | 3205233430 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2019 | ||||||||
| LastUpdateDate: | 09/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | AP142533 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.