Provider Demographics
NPI:1275176232
Name:POPE, BONNIE LEIGH (APRN)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:LEIGH
Last Name:POPE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:LEIGH
Other - Last Name:ROBERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 ST LUCIA
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-5325
Mailing Address - Country:US
Mailing Address - Phone:512-669-2471
Mailing Address - Fax:
Practice Address - Street 1:901 W BEN WHITE BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-6903
Practice Address - Country:US
Practice Address - Phone:512-816-8622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX143020363LF0000X
TXAP143020363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX404364801Medicaid