Provider Demographics
NPI:1821197203
Name:HAWKINS, DEBORAH LEIGH (CRNA)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:LEIGH
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 CLARK POINT TER
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-9748
Mailing Address - Country:US
Mailing Address - Phone:304-546-9662
Mailing Address - Fax:304-768-2468
Practice Address - Street 1:4605 MACCORKLE AVE SW
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1311
Practice Address - Country:US
Practice Address - Phone:304-344-0096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV50592163W00000X
WV70067367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV27-3419445OtherTAX ID
WV2603881000Medicaid
WVP00082314OtherR MEDICA
WV27-3419445OtherTAX ID
WV8245744Medicare PIN
WVNE7318071Medicare ID - Type Unspecified
WV2603881000Medicaid