Healthcare Provider Details

I. General information

NPI: 1659037679
Provider Name (Legal Business Name): TAYLOR HAWKINS MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2021
Last Update Date: 11/14/2021
Certification Date: 11/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 W CHECKERSPOT DR
TUCSON AZ
85741-5232
US

IV. Provider business mailing address

2727 W CHECKERSPOT DR
TUCSON AZ
85741-5232
US

V. Phone/Fax

Practice location:
  • Phone: 330-806-2374
  • Fax:
Mailing address:
  • Phone: 330-806-2374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86081214
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: