Provider Demographics
NPI:1043380363
Name:HAWES, MISSY S (NP)
Entity Type:Individual
Prefix:MRS
First Name:MISSY
Middle Name:S
Last Name:HAWES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776879
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6879
Mailing Address - Country:US
Mailing Address - Phone:502-559-9415
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:3026 POPLAR LEVEL RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1301
Practice Address - Country:US
Practice Address - Phone:502-636-4929
Practice Address - Fax:502-394-3629
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY30003657363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily