Provider Demographics
NPI:1083330336
Name:HAWKINS, JOLYN KAYE
Entity Type:Individual
Prefix:
First Name:JOLYN
Middle Name:KAYE
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 N KILGORE ST
Mailing Address - Street 2:
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-6054
Mailing Address - Country:US
Mailing Address - Phone:903-522-4199
Mailing Address - Fax:903-522-4015
Practice Address - Street 1:1016 N KILGORE ST
Practice Address - Street 2:
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-6054
Practice Address - Country:US
Practice Address - Phone:903-522-4199
Practice Address - Fax:903-522-4015
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1096866363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily