Individual
MRS. KIMBERLY M HAWKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1241 W STADIUM BLVD, JEFFERSON CITY, MO 65109-6023
(573) 636-5248
(573) 636-9390
Mailing address
1241 W STADIUM BLVD, JEFFERSON CITY, MO 65109-6023
(573) 636-5248
(573) 636-9390
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2005008762
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1417926676
GROUP NPI
—
01
—
990000530
GROUP MEDICARE PTAN
MO
Enumeration date
03/16/2006
Last updated
06/28/2023
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