Provider Demographics
NPI:1396256590
Name:OKWATA, DAVID ARUWA
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ARUWA
Last Name:OKWATA
Suffix:
Gender:M
Credentials:
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 26531
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-0531
Mailing Address - Country:US
Mailing Address - Phone:512-300-7297
Mailing Address - Fax:
Practice Address - Street 1:540 W. HWY 29
Practice Address - Street 2:
Practice Address - City:BERTRAM
Practice Address - State:TX
Practice Address - Zip Code:78605-5681
Practice Address - Country:US
Practice Address - Phone:512-300-7297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135468363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily