Healthcare Provider Details

I. General information

NPI: 1750182119
Provider Name (Legal Business Name): RAVEN ELIZABETH DAVIS DNP, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

1225 PAUL WILLIAMS DR
RAYMOND MS
39154-9495
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-5900
  • Fax:
Mailing address:
  • Phone: 601-951-4565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number901976
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: