Provider Demographics
NPI:1720392046
Name:BECK, BONNIE (PA)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:BECK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5517 ROLAND DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7626
Mailing Address - Country:US
Mailing Address - Phone:972-378-0390
Mailing Address - Fax:972-378-0391
Practice Address - Street 1:5517 ROLAND DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7626
Practice Address - Country:US
Practice Address - Phone:972-378-0390
Practice Address - Fax:972-378-0391
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05777363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant