Basic Information
| Provider Information | |||||||||
| NPI: | 1821197203 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAWKINS | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | LEIGH | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1914 CLARK POINT TER | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253149748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045469662 | ||||||||
| FaxNumber: | 3047682468 | ||||||||
| Practice Location | |||||||||
| Address1: | 4605 MACCORKLE AVE SW | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253091311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043440096 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 50592 | WV | N | Nursing Service Providers | Registered Nurse | 367500000X | 70067 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 27-3419445 | 01 | WV | TAX ID | OTHER | 2603881000 | 05 | WV | MEDICAID | P00082314 | 01 | WV | R MEDICA | OTHER |