Healthcare Provider Details

I. General information

NPI: 1932182557
Provider Name (Legal Business Name): GISELE MCKINNEY-HAWKINS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 11/15/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KINGSTON RD
SULPHUR LA
70663-4016
US

IV. Provider business mailing address

PO BOX 122585 DEPT 2585
DALLAS TX
75312-2585
US

V. Phone/Fax

Practice location:
  • Phone: 337-625-5843
  • Fax:
Mailing address:
  • Phone: 337-494-2921
  • Fax: 337-494-6523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD200379
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: