MEDICARE: KIMBERLY HAWKINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114383718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY HAWKINS

Provider Business Mailing Address
First Line	:	6827 SNOWMASS ST
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71119-7521
Country	:	US
Telephone Number	:	318-518-3948
Fax Number	:	318-754-4766

Provider Business Practice Location Address
First Line	:	3772 YOUREE DR
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71105-2132
Country	:	US
Telephone Number	:	318-670-3159
Fax Number	:	318-754-4766

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2016
Last Update Date	:	01/12/2016

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Directions to “ KIMBERLY HAWKINS ” Practice Location

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