Provider Demographics
NPI:1588698732
Name:HAWKINS, BRENDA A III (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:A
Last Name:HAWKINS
Suffix:III
Gender:F
Credentials:NURSE PRACTITIONER
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 70403
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37614-1703
Mailing Address - Country:US
Mailing Address - Phone:423-439-4078
Mailing Address - Fax:423-439-4060
Practice Address - Street 1:1901 S SHADY ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN CITY
Practice Address - State:TN
Practice Address - Zip Code:37683-2021
Practice Address - Country:US
Practice Address - Phone:423-727-1150
Practice Address - Fax:423-727-1152
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN05714363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3348482Medicaid
TN4032280OtherBLUECROSSBLUESHIELD
TNTN01G3OtherJOHN DEERE
TN4032280OtherBLUECROSSBLUESHIELD
TNTN01G3OtherJOHN DEERE
R63076Medicare UPIN