Provider Demographics
NPI:1134766603
Name:HAWKINS, TABATHA L (APRN)
Entity type:Individual
Prefix:
First Name:TABATHA
Middle Name:L
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1553
Mailing Address - Country:US
Mailing Address - Phone:270-216-6216
Mailing Address - Fax:270-245-1013
Practice Address - Street 1:436 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1553
Practice Address - Country:US
Practice Address - Phone:270-216-6216
Practice Address - Fax:270-245-1013
Is Sole Proprietor?:No
Enumeration Date:2019-12-04
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3017292363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health