Provider Demographics
NPI:1922988773
Name:HAWKINS, KIMBERLLI S
Entity type:Individual
Prefix:
First Name:KIMBERLLI
Middle Name:S
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 FAIRLAWN AVE SW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-3417
Mailing Address - Country:US
Mailing Address - Phone:330-268-2952
Mailing Address - Fax:
Practice Address - Street 1:521 FAIRLAWN AVE SW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-3417
Practice Address - Country:US
Practice Address - Phone:330-268-2952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH347C00000X, 372600000X, 343900000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No347C00000XTransportation ServicesPrivate Vehicle
No372600000XNursing Service Related ProvidersAdult Companion
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)