Individual
BONNIE SCHULTZ HUCKABY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MPAS, PA-C
Contact information
Practice address
1971 E 4TH ST STE 200, SANTA ANA, CA 92705-3917
(888) 959-5192
Mailing address
4301 LAKE BREEZE CT, FORT WORTH, TX 76132
(817) 707-0707
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA04247
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
328451501
—
TX
Enumeration date
07/28/2005
Last updated
09/29/2022
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