=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295123842
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VIVIAN POWTAKIEN ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2015
-----------------------------------------------------
Last Update Date | 03/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2140 N STATE HIGHWAY 121
-----------------------------------------------------
City | BONHAM
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75418-2346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 430-703-1550
-----------------------------------------------------
Fax | 430-703-1558
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2140 N STATE HIGHWAY 121
-----------------------------------------------------
City | BONHAM
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75418-2346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 430-703-1550
-----------------------------------------------------
Fax | 430-703-1558
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | AP141251
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------