Provider Demographics
NPI:1841273307
Name:HAWKINS-FROST, EDITH A (PA-C)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:A
Last Name:HAWKINS-FROST
Suffix:
Gender:F
Credentials:PA-C
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 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:303 E OVERTON RD
Practice Address - Street 2:BLUITT-FLOWERS HEALTH CENTER
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-5946
Practice Address - Country:US
Practice Address - Phone:214-266-4200
Practice Address - Fax:214-266-4218
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00161363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82N829OtherBLUE CROSS BLUE SHIELD
TX060361502Medicaid
TX060361503Medicaid
TXP00049543OtherRAILROAD MEDICARE
TX82N829OtherBLUE CROSS BLUE SHIELD
82N829Medicare PIN