Provider Demographics
NPI:1134004047
Name:HACKWORTH, LOLITA CHAVEZ (APRN)
Entity type:Individual
Prefix:
First Name:LOLITA
Middle Name:CHAVEZ
Last Name:HACKWORTH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 HUDSON BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:AR
Mailing Address - Zip Code:72007-9719
Mailing Address - Country:US
Mailing Address - Phone:580-339-4090
Mailing Address - Fax:
Practice Address - Street 1:1306 N CENTER ST
Practice Address - Street 2:
Practice Address - City:LONOKE
Practice Address - State:AR
Practice Address - Zip Code:72086-2011
Practice Address - Country:US
Practice Address - Phone:501-676-6560
Practice Address - Fax:501-676-6009
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR234542363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily