Provider Demographics
NPI:1942220611
Name:OWENS, BONNIE (NP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6957 W PLANO PKWY STE 1000
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-1621
Mailing Address - Country:US
Mailing Address - Phone:972-939-8294
Mailing Address - Fax:214-731-0240
Practice Address - Street 1:6957 W PLANO PKWY STE 1000
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-1621
Practice Address - Country:US
Practice Address - Phone:972-939-8294
Practice Address - Fax:214-731-0240
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX549165363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150605704Medicaid
TX150605702Medicaid
TX150605703Medicaid
TX88296HMedicare ID - Type Unspecified
TXS75914Medicare UPIN
TX8G2253Medicare ID - Type Unspecified
TX150605703Medicaid
TX150605704Medicaid
TXTXB100440Medicare PIN
TXTXB140611Medicare PIN