Provider Demographics
NPI:1831641448
Name:HAWKINS, BRENDA (NP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 PINES RD
Mailing Address - Street 2:2702
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-4442
Mailing Address - Country:US
Mailing Address - Phone:318-332-9604
Mailing Address - Fax:
Practice Address - Street 1:1111 HOMER RD
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-3027
Practice Address - Country:US
Practice Address - Phone:318-377-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-30
Last Update Date:2016-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09043363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily