MEDICARE: BONNIE AHRENS WALTER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	PA02950	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00404027	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245262187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE AHRENS WALTER PA-C

Provider Business Mailing Address
First Line	:	1651 W ROSEDALE ST STE 100
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-7437
Country	:	US
Telephone Number	:	817-930-2030
Fax Number	:

Provider Business Practice Location Address
First Line	:	1651 W ROSEDALE ST STE 100
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-7437
Country	:	US
Telephone Number	:	817-930-2030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	08/03/2023

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Directions to “ BONNIE AHRENS WALTER PA-C” Practice Location

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