Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | A01017 | AR |
NPI | 1013010610 |
---|---|
Provider Name | Naomi Ruth Hawkins |
First Address | Ratcliff, AR 72951 |
Second Address | Ratcliff, AR 72951 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 08/07/2007 |