Healthcare Provider Details

I. General information

NPI: 1750227443
Provider Name (Legal Business Name): RAVA HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 PEYCO DR N # B
ARLINGTON TX
76001-6701
US

IV. Provider business mailing address

7248 PORTILLO
GRAND PRAIRIE TX
75054-0073
US

V. Phone/Fax

Practice location:
  • Phone: 682-564-4685
  • Fax:
Mailing address:
  • Phone: 682-564-4685
  • Fax:

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 Number
License Number State

VIII. Authorized Official

Name: TITILOPE WITEMIRE
Title or Position: NP
Credential:
Phone: 682-564-4685