MEDICARE: JAMIE LYNN HAWKINS RN

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	163W00000X	Registered Nurse	R60276	NM
2	163WS0200X	School Registered Nurse	R60276	NM

General Provider Information

NPI Number	:	1194412577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE LYNN HAWKINS RN

Provider Business Mailing Address
First Line	:	17 CAMINO SABANERO
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87508-4836
Country	:	US
Telephone Number	:	505-690-1539
Fax Number	:

Provider Business Practice Location Address
First Line	:	4851 PASEO DEL SOL
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-3027
Country	:	US
Telephone Number	:	505-231-8831
Fax Number	:

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

Provider Enumeration Date	:	04/18/2023
Last Update Date	:	05/21/2024

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