Healthcare Provider Details

I. General information

NPI: 1699245480
Provider Name (Legal Business Name): MADISON JOY HAWKINS PLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2018
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 MEDICAL DR
MANILA AR
72442-8416
US

IV. Provider business mailing address

920 MEDICAL DR
MANILA AR
72442-8416
US

V. Phone/Fax

Practice location:
  • Phone: 870-570-0358
  • Fax: 870-570-0359
Mailing address:
  • Phone: 870-570-0358
  • Fax: 870-570-0359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: