Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 1-122277 | AL |
N | 363LP0222X | Nurse Practitioner Pediatrics (Critical Care) | 1-122277 | AL |
NPI | 1003160177 |
---|---|
Provider Name | Ms. Carly Rae Hawkins |
First Address | Birmingham, AL 35233-1711 |
Second Address | Birmingham, AL 35233-1711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2012 |
Last Update Date | 17/12/2020 |