Provider Demographics
NPI:1659098887
Name:HAWKINS, KRISTINE ANN (PLPC)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:ANN
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:ANN
Other - Last Name:UPCHURCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:402 S SILVER SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-7536
Mailing Address - Country:US
Mailing Address - Phone:573-334-1100
Mailing Address - Fax:573-651-4345
Practice Address - Street 1:103 EL NATHAN DRIVE
Practice Address - Street 2:
Practice Address - City:MARBLE HILL
Practice Address - State:MO
Practice Address - Zip Code:63764-6376
Practice Address - Country:US
Practice Address - Phone:573-238-1027
Practice Address - Fax:573-238-1171
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022040476101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health