MEDICARE: RAVEN CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP07502	LA
2	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1861825929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAVEN CLINIC

Provider Business Mailing Address
First Line	:	8080 CROWDER BLVD STE E
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70127-1077
Country	:	US
Telephone Number	:	504-459-2430
Fax Number	:	281-595-1241

Provider Business Practice Location Address
First Line	:	8080 CROWDER BLVD STE E
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70127-1077
Country	:	US
Telephone Number	:	504-514-1247
Fax Number	:	281-595-1241

Authorized Official
Title or Position	:	CEO
Name	:	MR. ROBERT J JEMISON
Credential	:	FNP-C
Telephone Number	:	504-459-2430

Provider Enumeration Date	:	08/13/2013
Last Update Date	:	04/03/2026

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Directions to “RAVEN CLINIC ” Practice Location

Language	Start Address	Practice Location

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