MEDICARE: KDAWKINS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1063995744
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KDAWKINS LLC

Provider Business Mailing Address
First Line	:	PO BOX 2682
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32203-2682
Country	:	US
Telephone Number	:	904-445-8322
Fax Number	:

Provider Business Practice Location Address
First Line	:	841 PRUDENTIAL DR # 1229
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-8329
Country	:	US
Telephone Number	:	904-445-8322
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KEITH DAWKINS
Credential	:
Telephone Number	:	904-445-8322

Provider Enumeration Date	:	09/10/2018
Last Update Date	:	02/06/2019

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Directions to “KDAWKINS LLC ” Practice Location

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