Provider Demographics
NPI:1386732881
Name:HAWKINS-KOCH, DOROVENIA NICOLE (DO)
Entity type:Individual
Prefix:DR
First Name:DOROVENIA
Middle Name:NICOLE
Last Name:HAWKINS-KOCH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 E GENERAL CAVAZOS BLVD
Mailing Address - Street 2:STE 305
Mailing Address - City:KINGSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78363-7150
Mailing Address - Country:US
Mailing Address - Phone:361-592-2223
Mailing Address - Fax:
Practice Address - Street 1:1311 E GENERAL CAVAZOS BLVD
Practice Address - Street 2:STE 305
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363-7150
Practice Address - Country:US
Practice Address - Phone:361-592-2223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4810207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX107604401Medicaid
TX137248402Medicaid
TX137248411Medicaid
TX184438302Medicaid
TX137248412Medicaid
TX184438301Medicaid
TXM4810OtherLICENSE
TX8H9136OtherBCBS
TX453828Medicare ID - Type UnspecifiedBRENHAM RH
TXM4810OtherLICENSE
TX8H9136OtherBCBS
TX137248412Medicaid
TX184438302Medicaid
TX8F23153Medicare PIN