Provider Demographics
NPI:1457133977
Name:HAWKER, LOGAN MAKAYLA (PA)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:MAKAYLA
Last Name:HAWKER
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:LOGAN
Other - Middle Name:
Other - Last Name:DAVILA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1066 S SILVERSTONE WAY APT C230
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1365
Mailing Address - Country:US
Mailing Address - Phone:541-212-3842
Mailing Address - Fax:
Practice Address - Street 1:1906 S VISTA AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-3453
Practice Address - Country:US
Practice Address - Phone:503-554-2521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program