Healthcare Provider Details

I. General information

NPI: 1326957473
Provider Name (Legal Business Name): KEITH HAWKINS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4119 LAUREL ST
ANCHORAGE AK
99508-5334
US

IV. Provider business mailing address

4543 LAKE OTIS PKWY APT 2
ANCHORAGE AK
99507-1442
US

V. Phone/Fax

Practice location:
  • Phone: 907-415-8259
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: