Provider Demographics
NPI:1871004028
Name:HAWKINS, TAMATHA YVETTE (NP)
Entity Type:Individual
Prefix:
First Name:TAMATHA
Middle Name:YVETTE
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:PO BOX 1034
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71221-1034
Mailing Address - Country:US
Mailing Address - Phone:318-499-1570
Mailing Address - Fax:318-232-4129
Practice Address - Street 1:648 E JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-7122
Practice Address - Country:US
Practice Address - Phone:318-499-1570
Practice Address - Fax:318-232-4129
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-16
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA09628363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty