Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 3004675 | KY |
N | 363LP0200X | Nurse Practitioner - Pediatrics | 4675P | KY |
NPI | 1003956426 |
---|---|
Provider Name | Mrs. Elizabeth Ann Hawkins |
First Address | Bowling Green, KY 42101-1759 |
Second Address | Bowling Green, KY 42101-1759 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 12/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
78015252 | (05) | KY |