=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396256590
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID ARUWA OKWATA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2017
-----------------------------------------------------
Last Update Date | 03/09/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 540 W. HWY 29
-----------------------------------------------------
City | BERTRAM
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78605-5681
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-300-7297
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 26531
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78755-0531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-300-7297
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP135468
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------