Provider Demographics
NPI:1881291425
Name:HAWKINS, JULIE (DO)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10175 COUNTY ROAD 180
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-7247
Mailing Address - Country:US
Mailing Address - Phone:417-355-3543
Mailing Address - Fax:
Practice Address - Street 1:10175 COUNTY ROAD 180
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-7247
Practice Address - Country:US
Practice Address - Phone:417-355-3543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC001555268374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO82-4320761Medicaid