Healthcare Provider Details

I. General information

NPI: 1548179831
Provider Name (Legal Business Name): RAVEN OLIPHANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 E 29TH ST N
WICHITA KS
67226-2169
US

IV. Provider business mailing address

1042 N PERSHING ST
WICHITA KS
67208-2826
US

V. Phone/Fax

Practice location:
  • Phone: 316-634-8710
  • Fax: 316-634-8891
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: