MEDICARE: MRS. JACQUELINE LEIGH HAWKINS FNP

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	363LF0000X	Family Nurse Practitioner	5375379091	KS
2	363LF0000X	Family Nurse Practitioner	2011010122	MO

General Provider Information

NPI Number	:	1154612307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACQUELINE LEIGH HAWKINS FNP

Provider Business Mailing Address
First Line	:	2800 CLAY EDWARDS DRIVE,
Second Line	:	CENTRAL VERIFICATION OFFICE AND PAYOR ENROLLMENT
City	:	NORTH KANSAS CITY
State	:	MO
Zip	:	64116
Country	:	US
Telephone Number	:	816-691-1655
Fax Number	:

Provider Business Practice Location Address
First Line	:	9411 N OAK TRFY STE 205
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64155-2229
Country	:	US
Telephone Number	:	816-691-3546
Fax Number	:	816-346-7474

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

Provider Enumeration Date	:	04/22/2011
Last Update Date	:	04/17/2026

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