Healthcare Provider Details

I. General information

NPI: 1326951195
Provider Name (Legal Business Name): KATELYN HAWKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 GOLF COURSE RD SE STE B&C
RIO RANCHO NM
87124-1999
US

IV. Provider business mailing address

1207 GOLF COURSE RD SE STE B&C
RIO RANCHO NM
87124-1999
US

V. Phone/Fax

Practice location:
  • Phone: 505-227-8386
  • Fax: 505-891-8403
Mailing address:
  • Phone: 505-227-8386
  • Fax: 505-891-8403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberINTERN
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: