Healthcare Provider Details

I. General information

NPI: 1134779747
Provider Name (Legal Business Name): KELLI ANN CRAVEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HEALTHY WAY
OLIVIA MN
56277-1117
US

IV. Provider business mailing address

PO BOX 341
WANBLEE SD
57577-0341
US

V. Phone/Fax

Practice location:
  • Phone: 320-523-3483
  • Fax: 320-523-3430
Mailing address:
  • Phone: 713-703-6989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAP142533
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704406162
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71017248A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2261377
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: