Provider Demographics
NPI:1902803877
Name:HAWKINS, PATRICK DALE (DNP,ANP, NP-C)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:DALE
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:DNP,ANP, NP-C
Other - Prefix:DR
Other - First Name:PATRICK
Other - Middle Name:DALE
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP, ANPNP-C
Mailing Address - Street 1:2486 NERREDIA STREET, SUITE E
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-4807
Mailing Address - Country:US
Mailing Address - Phone:810-230-9901
Mailing Address - Fax:
Practice Address - Street 1:2486 NERREDIA ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-4807
Practice Address - Country:US
Practice Address - Phone:810-230-9901
Practice Address - Fax:810-230-9916
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704200480363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104626142Medicaid
MI104626142Medicaid
MIN82600006Medicare ID - Type Unspecified