Provider Demographics
NPI:1730692914
Name:HAWKINS, KENNETH WAYNE JR (MSN, FNP)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:WAYNE
Last Name:HAWKINS
Suffix:JR
Gender:M
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 TARA DR
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-1633
Mailing Address - Country:US
Mailing Address - Phone:662-501-6068
Mailing Address - Fax:
Practice Address - Street 1:4364 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:SENATOBIA
Practice Address - State:MS
Practice Address - Zip Code:38668-2534
Practice Address - Country:US
Practice Address - Phone:662-560-5966
Practice Address - Fax:662-560-5969
Is Sole Proprietor?:No
Enumeration Date:2017-11-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902293363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00772751Medicaid
MS00772751Medicaid