Individual
JACOB HAWKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, ATC
Contact information
Practice address
224 S WOODS MILL RD # 330, CHESTERFIELD, MO 63017-3513
(314) 576-7013
Mailing address
708 E KINGSBURY ST, SPRINGFIELD, MO 65807-2027
(815) 979-4246
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
2020026175
MO
2255A2300X
Athletic Trainer
—
—
363A00000X
Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/08/2019
Last updated
01/20/2025
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