Healthcare Provider Details

I. General information

NPI: 1467235192
Provider Name (Legal Business Name): BRITTANY K HAWKES PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRITTANY K POOLE

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 W REUNION AVE STE 5A
SOUTH JORDAN UT
84095-4620
US

IV. Provider business mailing address

11092 S OLD BRIDGE RD
SOUTH JORDAN UT
84009-1617
US

V. Phone/Fax

Practice location:
  • Phone: 385-361-3001
  • Fax:
Mailing address:
  • Phone: 208-680-7947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14029242-1206
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number14029242-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: