Healthcare Provider Details

I. General information

NPI: 1861825929
Provider Name (Legal Business Name): RAVEN CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8080 CROWDER BLVD STE E
NEW ORLEANS LA
70127-1077
US

IV. Provider business mailing address

8080 CROWDER BLVD STE E
NEW ORLEANS LA
70127-1077
US

V. Phone/Fax

Practice location:
  • Phone: 504-514-1247
  • Fax: 281-595-1241
Mailing address:
  • Phone: 504-459-2430
  • Fax: 281-595-1241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP07502
License Number StateLA

VIII. Authorized Official

Name: MR. ROBERT J JEMISON
Title or Position: CEO
Credential: FNP-C
Phone: 504-459-2430