Provider Demographics
NPI:1861238479
Name:CRAVEN, DESTINY (APRN, PMHNP)
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:
Last Name:CRAVEN
Suffix:
Gender:F
Credentials:APRN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-2834
Mailing Address - Country:US
Mailing Address - Phone:217-223-8400
Mailing Address - Fax:217-773-7107
Practice Address - Street 1:521 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:IL
Practice Address - Zip Code:62353-1378
Practice Address - Country:US
Practice Address - Phone:217-285-2113
Practice Address - Fax:217-773-7107
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209029940363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health