Provider Demographics
NPI:1457782260
Name:HAWKINS, STEPHANIE (PNP-BC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:PNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 CARTER DR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-7240
Mailing Address - Country:US
Mailing Address - Phone:903-439-5189
Mailing Address - Fax:903-438-1107
Practice Address - Street 1:2945 RENWICK ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-8146
Practice Address - Country:US
Practice Address - Phone:318-654-8760
Practice Address - Fax:318-605-2374
Is Sole Proprietor?:No
Enumeration Date:2013-12-03
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA234409363LP0200X
TXAP126597363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX752950731OtherTAX ID
TX347490001Medicaid
TX347490002Medicaid