Provider Demographics
NPI:1407524606
Name:HAWES, KELLY PAMELA (LM, CPM, IBCLC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:PAMELA
Last Name:HAWES
Suffix:
Gender:F
Credentials:LM, CPM, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 FOREST AVE STE B7
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-3368
Mailing Address - Country:US
Mailing Address - Phone:831-402-8500
Mailing Address - Fax:831-288-1523
Practice Address - Street 1:311 FOREST AVE STE B7
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-3368
Practice Address - Country:US
Practice Address - Phone:831-402-8500
Practice Address - Fax:831-288-1523
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-316061174N00000X
CA658176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No174N00000XOther Service ProvidersLactation Consultant, Non-RN