Provider Demographics
NPI:1912012121
Name:DAWKINS, PAULETTE (CFNP)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:
Last Name:DAWKINS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:PAULETTE
Other - Middle Name:
Other - Last Name:HODA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CFNP
Mailing Address - Street 1:1110 BROAD AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-8907
Mailing Address - Country:US
Mailing Address - Phone:228-864-0314
Mailing Address - Fax:228-864-0425
Practice Address - Street 1:1612 31ST AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2750
Practice Address - Country:US
Practice Address - Phone:228-864-8454
Practice Address - Fax:228-865-1457
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR813565363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00192859OtherRAILROAD MEDICARE
MS08229286Medicaid
MS08229286Medicaid
MS302I505950Medicare PIN
MS512I500498Medicare PIN
MS500001735Medicare ID - Type Unspecified
MS00192859OtherRAILROAD MEDICARE