Healthcare Provider Details

I. General information

NPI: 1851837165
Provider Name (Legal Business Name): PATRICIA HAWK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1296 SKILL CENTER CIR
TAHLEQUAH OK
74464-6444
US

IV. Provider business mailing address

1296 SKILL CENTER CIR
TAHLEQUAH OK
74464-6444
US

V. Phone/Fax

Practice location:
  • Phone: 918-452-5000
  • Fax: 918-452-6151
Mailing address:
  • Phone: 918-452-5000
  • Fax: 918-452-6151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number41093
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number41093
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: