Healthcare Provider Details

I. General information

NPI: 1336739291
Provider Name (Legal Business Name): AMELIA RUTH HAWKINS RN, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2021
Last Update Date: 04/30/2023
Certification Date: 04/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 E 15TH ST STE 205
TULSA OK
74120-5851
US

IV. Provider business mailing address

414 YORKTOWN ST
WAGONER OK
74467-3554
US

V. Phone/Fax

Practice location:
  • Phone: 918-300-4939
  • Fax:
Mailing address:
  • Phone: 918-513-2306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number205331
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: