Healthcare Provider Details

I. General information

NPI: 1184530164
Provider Name (Legal Business Name): BRENDA HAWKINS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63025 WEST END BLVD SUITE 200
SLIDELL LA
70461
US

IV. Provider business mailing address

63025 WEST END BLVD SUITE 200
SLIDELL LA
70461
US

V. Phone/Fax

Practice location:
  • Phone: 985-639-3777
  • Fax:
Mailing address:
  • Phone: 985-639-3777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberAP217976
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: