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NPI Code Detail

MEDICARE: BENJAMIN RAWSON HAWTHORNE FNP-C

MEDICARE: BENJAMIN RAWSON HAWTHORNE FNP-C
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
1363LF0000XFamily Nurse Practitioner906745MS

General Provider Information

NPI Number : 1346082161
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN RAWSON HAWTHORNE FNP-C
Provider Business Mailing Address
First Line : 350 N HUMPHREYS BLVD
Second Line :
City : MEMPHIS
State : TN
Zip : 38120-2177
Country : US
Telephone Number : 901-226-4003
Fax Number : 901-227-8591
Provider Business Practice Location Address
First Line : 1325 E FORTIFICATION ST
Second Line :
City : JACKSON
State : MS
Zip : 39202-2442
Country : US
Telephone Number : 601-397-4844
Fax Number : 601-351-5980
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2024
Last Update Date : 05/27/2026

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