Provider Demographics
NPI:1407824279
Name:HAWKINS, MARTHA D (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:D
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 WELLINGTON WAY
Mailing Address - Street 2:SUITE 275
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1259
Mailing Address - Country:US
Mailing Address - Phone:859-219-2828
Mailing Address - Fax:859-219-2845
Practice Address - Street 1:1055 WELLINGTON WAY
Practice Address - Street 2:SUITE 120
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1259
Practice Address - Country:US
Practice Address - Phone:859-219-2828
Practice Address - Fax:859-219-2845
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004019363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78009677Medicaid
KY000000321166OtherANTHEN BC BS HHC
KY78009677OtherPASSPORT HEALTH HHC
KY78009677OtherPASSPORT HEALTH HHC
KYQ11943Medicare UPIN