Healthcare Provider Details

I. General information

NPI: 1407181423
Provider Name (Legal Business Name): MEGAN SUZANNE HAWKINS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2704 N TENAYA WAY
LAS VEGAS NV
89128-0424
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 702-243-8500
  • Fax: 702-363-8753
Mailing address:
  • Phone: 702-838-8265
  • Fax: 702-804-3788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1186
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: