Healthcare Provider Details

I. General information

NPI: 1619709581
Provider Name (Legal Business Name): RAVEN DARNELL COLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RAVEN PREETI DARNELL APRN

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S LANCASTER RD
DALLAS TX
75216-7167
US

IV. Provider business mailing address

103 KINCAID DR
SANGER TX
76266-6642
US

V. Phone/Fax

Practice location:
  • Phone: 214-742-8387
  • Fax:
Mailing address:
  • Phone: 720-746-8047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1171301
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: