Basic Information
Provider Information
NPI: 1184656530
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HAWKINS
FirstName: HOLLIE
MiddleName: LEA
NamePrefix:  
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: TWIBELL
OtherFirstName: HOLLIE
OtherMiddleName: LEA
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: PO BOX 268838
Address2:  
City: OKLAHOMA CITY
State: OK
PostalCode: 731268838
CountryCode: US
TelephoneNumber: 9185881900
FaxNumber: 9185826405
Practice Location
Address1: 4444 E. 41ST ST
Address2: 2ND FLOOR, STE A
City: TULSA
State: OK
PostalCode: 741352527
CountryCode: US
TelephoneNumber: 9186194300
FaxNumber: 9186194322
Other Information
ProviderEnumerationDate: 07/07/2006
LastUpdateDate: 07/06/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0200XR29735OKY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics

No ID Information.


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