Provider Demographics
NPI:1780268599
Name:CRAVENS, TODD MICHAEL (PA-C)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:MICHAEL
Last Name:CRAVENS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:ATTN CREDENTIALING
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-418-0941
Practice Address - Street 1:330 FALCON RIDGE PKWY STE 400A
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-8881
Practice Address - Country:US
Practice Address - Phone:435-628-9393
Practice Address - Fax:435-628-9382
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT13246617-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant