Provider Demographics
NPI:1467235192
Name:HAWKES, BRITTANY K (PA)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:K
Last Name:HAWKES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:K
Other - Last Name:POOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11092 S OLD BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-1617
Mailing Address - Country:US
Mailing Address - Phone:208-680-7947
Mailing Address - Fax:
Practice Address - Street 1:11092 S OLD BRIDGE RD
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84009-1617
Practice Address - Country:US
Practice Address - Phone:208-680-7947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant