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NPI Code Detail

MEDICARE: REBECCA HAWTHORNE

MEDICARE: REBECCA HAWTHORNE
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
1363A00000XPhysician AssistantPA10183TX

General Provider Information

NPI Number : 1790155620
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA HAWTHORNE
Provider Business Mailing Address
First Line : 7630 N BEACH ST STE 140
Second Line :
City : FORT WORTH
State : TX
Zip : 76137-3016
Country : US
Telephone Number : 817-281-2977
Fax Number : 817-788-2530
Provider Business Practice Location Address
First Line : 7630 N BEACH ST STE 140
Second Line :
City : FORT WORTH
State : TX
Zip : 76137-3016
Country : US
Telephone Number : 817-281-2977
Fax Number : 817-788-2530
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2015
Last Update Date : 08/20/2025

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Directions to “ REBECCA HAWTHORNE ” Practice Location

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