MEDICARE: MRS. TRACI HAWKINS NP

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	363L00000X	Nurse Practitioner	1168953	TX

General Provider Information

NPI Number	:	1205674033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRACI HAWKINS NP

Provider Business Mailing Address
First Line	:	2100 ALAMO RD STE 110
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75080-2749
Country	:	US
Telephone Number	:	214-728-3357
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 ALAMO RD STE 110
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75080-2749
Country	:	US
Telephone Number	:	214-728-3357
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2024
Last Update Date	:	07/16/2024

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