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NPI Code Detail

MEDICARE: MR. SAM HAWKINS JR.

MEDICARE: MR. SAM HAWKINS JR.
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner863551NV

General Provider Information

NPI Number : 1912695487
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SAM HAWKINS JR.
Provider Business Mailing Address
First Line : 5257 KALMIA DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89103-1307
Country : US
Telephone Number : 702-704-8685
Fax Number :
Provider Business Practice Location Address
First Line : 911 N BUFFALO DR UNIT 206
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-0381
Country : US
Telephone Number : 702-704-8685
Fax Number : 702-405-6066
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2023
Last Update Date : 01/13/2026

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