Provider Demographics
NPI:1902997927
Name:HAWKINS, KIMBERLY JOAN (NP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:JOAN
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:NP
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 850
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-0850
Mailing Address - Country:US
Mailing Address - Phone:423-787-0680
Mailing Address - Fax:423-787-7720
Practice Address - Street 1:2994 CAMP CREEK RD
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-6064
Practice Address - Country:US
Practice Address - Phone:423-787-0680
Practice Address - Fax:423-787-7720
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6649363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily