Provider Demographics
NPI:1831221803
Name:HAWKINS, CANDICE CONEY (PT)
Entity type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:CONEY
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 CRESTHILL DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-5666
Mailing Address - Country:US
Mailing Address - Phone:337-857-9477
Mailing Address - Fax:
Practice Address - Street 1:207 CRESTHILL DR
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-5666
Practice Address - Country:US
Practice Address - Phone:337-857-9477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01583225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1326321Medicaid