Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | 243348 | MA |
Y | 207W00000X | Ophthalmologist | P0832 | TX |
NPI | 1003019092 |
---|---|
Provider Name | Dr. Kristen Michelle Hawthorne |
First Address | Austin, TX 78704-5703 |
Second Address | Austin, TX 78704-5703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2007 |
Last Update Date | 25/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
285890401 | (05) | TX |
DEA | FH2018136 (01) | TX |