Provider Demographics
NPI:1609906353
Name:HAWKINS, AMY K
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:K
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:K
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:135 WEST OREGON AVENUE
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:OH
Mailing Address - Zip Code:44672
Mailing Address - Country:US
Mailing Address - Phone:330-938-2382
Mailing Address - Fax:
Practice Address - Street 1:1410 W STATE STREET
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460
Practice Address - Country:US
Practice Address - Phone:330-337-3026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400385430704374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2626055OtherMEDICAID INDEPENDENT HEAL
OH400385430704STNAOtherCARE PROVIDER