Healthcare Provider Details

I. General information

NPI: 1487150231
Provider Name (Legal Business Name): KIMBERLY ANN HAWKINS CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 04/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 WARREN ST NE
WASHINGTON DC
20002-6429
US

IV. Provider business mailing address

201 WARREN ST NE
WASHINGTON DC
20002-6429
US

V. Phone/Fax

Practice location:
  • Phone: 202-834-5853
  • Fax:
Mailing address:
  • Phone: 202-834-5853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number280674
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: