Provider Demographics
NPI:1104474428
Name:HAWKINS, KRYSTAL HOWARD (PMHNP)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:HOWARD
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:NICOLE
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2810 SAINT MARYS VIEW RD
Mailing Address - Street 2:
Mailing Address - City:ACCOKEEK
Mailing Address - State:MD
Mailing Address - Zip Code:20607-3767
Mailing Address - Country:US
Mailing Address - Phone:703-407-7612
Mailing Address - Fax:
Practice Address - Street 1:3300 GALLOWS RD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3307
Practice Address - Country:US
Practice Address - Phone:703-776-4001
Practice Address - Fax:703-776-7113
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR1934252084P0800X
VA0024178525363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry