Provider Demographics
NPI:1568180966
Name:HAWKINS, REGAN ALEXANDRA (RD, LD)
Entity Type:Individual
Prefix:
First Name:REGAN
Middle Name:ALEXANDRA
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20676 MIXON RD
Mailing Address - Street 2:
Mailing Address - City:TROUP
Mailing Address - State:TX
Mailing Address - Zip Code:75789-5044
Mailing Address - Country:US
Mailing Address - Phone:903-312-6049
Mailing Address - Fax:
Practice Address - Street 1:20676 MIXON RD
Practice Address - Street 2:
Practice Address - City:TROUP
Practice Address - State:TX
Practice Address - Zip Code:75789-5044
Practice Address - Country:US
Practice Address - Phone:903-312-6049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT87964133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered