Healthcare Provider Details

I. General information

NPI: 1649299348
Provider Name (Legal Business Name): THOMAS CRAVENS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 SAMARITAN DR
LAS CRUCES NM
88001-1170
US

IV. Provider business mailing address

7550 PYRAMID PEAK LN
LAS CRUCES NM
88011-8386
US

V. Phone/Fax

Practice location:
  • Phone: 800-421-8274
  • Fax:
Mailing address:
  • Phone: 314-910-1738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number113575
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA00749
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: