Provider Demographics
NPI:1821622002
Name:HAWTHORNE, JAMIE DANIELLE (RN)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:DANIELLE
Last Name:HAWTHORNE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7655 FM 1398
Mailing Address - Street 2:
Mailing Address - City:HOOKS
Mailing Address - State:TX
Mailing Address - Zip Code:75561-6670
Mailing Address - Country:US
Mailing Address - Phone:870-703-7619
Mailing Address - Fax:
Practice Address - Street 1:2600 SAINT MICHAEL DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2372
Practice Address - Country:US
Practice Address - Phone:903-614-2688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX871264163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse