Provider Demographics
NPI:1659094712
Name:HAWKINS, ANGEL MARIE (WC, RSS)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:MARIE
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:WC, RSS
Other - Prefix:
Other - First Name:ANGEL
Other - Middle Name:MARIE
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:WC, RSS
Mailing Address - Street 1:100 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5369
Mailing Address - Country:US
Mailing Address - Phone:405-669-5618
Mailing Address - Fax:
Practice Address - Street 1:100 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5369
Practice Address - Country:US
Practice Address - Phone:918-426-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKJ083424867171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK357388OtherHEALTHCHOICE