MEDICARE: AYANNA 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	302R00000X	Health Maintenance Organization
2	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1841849791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYANNA HAWKINS

Provider Business Mailing Address
First Line	:	1294 WHITE OAK RD
Second Line	:
City	:	TUNICA
State	:	MS
Zip	:	38676-9743
Country	:	US
Telephone Number	:	662-613-9566
Fax Number	:

Provider Business Practice Location Address
First Line	:	1294 WHITE OAK RD
Second Line	:
City	:	TUNICA
State	:	MS
Zip	:	38676-9743
Country	:	US
Telephone Number	:	662-613-9566
Fax Number	:

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

Provider Enumeration Date	:	09/04/2019
Last Update Date	:	09/04/2019

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Directions to “ AYANNA HAWKINS ” Practice Location

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