Provider Demographics
NPI:1265624423
Name:SAMSON, BONNIE ARP (PA)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:ARP
Last Name:SAMSON
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1860
Mailing Address - Fax:
Practice Address - Street 1:4443 N JOSEY LN STE 150
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4680
Practice Address - Country:US
Practice Address - Phone:972-820-7595
Practice Address - Fax:972-820-7549
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02570363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGOtherORDERING/REFERRING TPI
TX8K5767Medicare PIN
TXTXB123689Medicare PIN