Provider Demographics
NPI:1982271326
Name:HAWKINS, JOMECA S
Entity Type:Individual
Prefix:
First Name:JOMECA
Middle Name:S
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 S EDMONDS LN APT 102
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-4407
Mailing Address - Country:US
Mailing Address - Phone:504-708-3952
Mailing Address - Fax:
Practice Address - Street 1:1002 S EDMONDS LN APT 102
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-4407
Practice Address - Country:US
Practice Address - Phone:504-708-3952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT129231405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional