Provider Demographics
NPI:1821667437
Name:HAWKINS, YLISHA DAVID
Entity Type:Individual
Prefix:
First Name:YLISHA
Middle Name:DAVID
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 LONG BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-6481
Mailing Address - Country:US
Mailing Address - Phone:443-945-8065
Mailing Address - Fax:
Practice Address - Street 1:370 LONG BRANCH DR
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-6481
Practice Address - Country:US
Practice Address - Phone:443-945-8065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care