Provider Demographics
NPI:1114607660
Name:KELLY-HAWKINS, TRICIA LASHUN (MSN, APRN, AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:LASHUN
Last Name:KELLY-HAWKINS
Suffix:
Gender:F
Credentials:MSN, APRN, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HIDALGO LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-3128
Mailing Address - Country:US
Mailing Address - Phone:817-228-9700
Mailing Address - Fax:
Practice Address - Street 1:120 HIDALGO LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-3128
Practice Address - Country:US
Practice Address - Phone:817-228-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1116825363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care