Provider Demographics
NPI:1114421849
Name:HAWKINS, JAMIE REYNELDA
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:REYNELDA
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 1:1507 LIVE OAK ST
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460-8811
Mailing Address - Country:US
Mailing Address - Phone:985-649-5844
Mailing Address - Fax:
Practice Address - Street 1:1507 LIVE OAK ST
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70460-8811
Practice Address - Country:US
Practice Address - Phone:985-649-5844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No172A00000XOther Service ProvidersDriver