Provider Demographics
NPI:1023645116
Name:CRAVEN, CHRISTINA MARRIE (AGNP-C)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARRIE
Last Name:CRAVEN
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 BERGER RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63359-5403
Mailing Address - Country:US
Mailing Address - Phone:573-721-5960
Mailing Address - Fax:
Practice Address - Street 1:9 TIFFANY LYNN CT
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-3257
Practice Address - Country:US
Practice Address - Phone:636-639-6280
Practice Address - Fax:636-639-6317
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020008023163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice