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NPI Code Detail

MEDICARE: RAVEN NICOLE RICHARD

MEDICARE: RAVEN NICOLE RICHARD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-23-291859OK
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1033893599
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAVEN NICOLE RICHARD
Provider Business Mailing Address
First Line : 2724 NW 111TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73120-6420
Country : US
Telephone Number : 405-441-8996
Fax Number :
Provider Business Practice Location Address
First Line : 416 W 15TH ST STE 600
Second Line :
City : EDMOND
State : OK
Zip : 73013-3672
Country : US
Telephone Number : 479-318-2300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2023
Last Update Date : 08/21/2023

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Directions to “ RAVEN NICOLE RICHARD ” Practice Location

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