MEDICARE: KYLE HAWKES MSN, RN

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	163W00000X	Registered Nurse	3461172	ID

General Provider Information

NPI Number	:	1437000650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE HAWKES MSN, RN

Provider Business Mailing Address
First Line	:	4650 HAWTHORNE RD STE 3B
Second Line	:
City	:	CHUBBUCK
State	:	ID
Zip	:	83202-2376
Country	:	US
Telephone Number	:	208-252-5621
Fax Number	:

Provider Business Practice Location Address
First Line	:	2280 E 25TH ST
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7542
Country	:	US
Telephone Number	:	208-227-2100
Fax Number	:

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

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/04/2026

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