Individual provider Active NPI

Raven Alexsis Verville, PA

  • Physician Assistant
  • Glendale, AZ
National Provider Identifier
1194655407
Registry record updated May 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
19555 N 59TH Ave
Glendale, AZ 85308-6813
Phone
(623) 572-3200
NPI assigned
May 20, 2026
Last updated
May 20, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X AZ Primary

Addresses

Primary practice location

19555 N 59TH Ave
Glendale, AZ 85308-6813

Mailing address

945 E Playa del Norte Dr Unit 1005
Tempe, AZ 85288-2276
Phone (530) 605-9528

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Physician Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1779235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779235200000",
    "number": "1194655407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "945 E PLAYA DEL NORTE DR UNIT 1005",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852882276",
            "telephone_number": "530-605-9528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19555 N 59TH AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853086813",
            "telephone_number": "623-572-3200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VERVILLE",
        "first_name": "RAVEN",
        "middle_name": "ALEXSIS",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-05-20",
        "last_updated": "2026-05-20",
        "certification_date": "2026-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.