Provider Demographics
NPI:1760022487
Name:HAWKINS, ELISE MONIQUE (DNP, APRN)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:MONIQUE
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 DUPONT CIR STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4881
Mailing Address - Country:US
Mailing Address - Phone:502-894-6066
Mailing Address - Fax:
Practice Address - Street 1:4010 DUPONT CIR STE 300
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4881
Practice Address - Country:US
Practice Address - Phone:502-894-6066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014169363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1730136995OtherGROUP NPI