Most Relevant Information
Provider Data
| NPI Number: | 1003673559 |
| Provider Name: | RAVEN THACKER NP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LG0600X |
| Specialty: | Nurse Practitioner |
| License Number: | 1136389 |
Most Important Dates
| Enumeration Date: | 03/01/2024 |
| Last Updated: | 04/30/2024 |
Provider Practice Location
1515 HOLCOMBE BLVD
HOUSTON
TX
770304000
Practice Location Phone/Fax
| Phone: | 7137926161 |
| Fax: |
Provider Mailing Location
P O BOX 4439
HOUSTON
TX
772104439
Provider Mailing Phone/Fax
| Phone: | 7137922991 |
| Fax: |