Provider Demographics
NPI:1457800518
Name:HAWKEN, JEFF
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:HAWKEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 SE ADAMS BLVD APT 909C
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-8600
Mailing Address - Country:US
Mailing Address - Phone:480-332-2565
Mailing Address - Fax:
Practice Address - Street 1:4715 SE ADAMS BLVD
Practice Address - Street 2:APT 909C
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-8639
Practice Address - Country:US
Practice Address - Phone:480-332-2565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator