Healthcare Provider Details

I. General information

NPI: 1053534560
Provider Name (Legal Business Name): MICHAEL KENT CRAVENS RRT,RFPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 SILLECT AVE STE 107
BAKERSFIELD CA
93308-6348
US

IV. Provider business mailing address

3101 SILLECT AVE STE 107
BAKERSFIELD CA
93308-6348
US

V. Phone/Fax

Practice location:
  • Phone: 661-631-8328
  • Fax: 661-631-8329
Mailing address:
  • Phone: 661-631-8328
  • Fax: 661-631-8329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2278P3900X
TaxonomyNeonatal/Pediatric Certified Respiratory Therapist
License NumberRCP13616
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRCP13616
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: