Provider Demographics
NPI:1558374231
Name:HAWKINS, STEPHEN R (PAC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:860 OMNI BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4430
Mailing Address - Country:US
Mailing Address - Phone:757-232-8769
Mailing Address - Fax:757-232-8875
Practice Address - Street 1:5424 DISCOVERY PARK BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2904
Practice Address - Country:US
Practice Address - Phone:757-206-1190
Practice Address - Fax:757-208-0601
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110001463363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1558374231OtherNPI
VA1558374231Medicaid
P00214253OtherMC RAILROAD
P00214253OtherMC RAILROAD