Provider Demographics
NPI:1104201730
Name:HUNT, DOMINIQUE (PA)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:
Last Name:HUNT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ATTN: NICOLE KYNE
Mailing Address - Street 2:7835 PARAGON RD.
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4021
Mailing Address - Country:US
Mailing Address - Phone:937-436-4148
Mailing Address - Fax:937-434-1266
Practice Address - Street 1:5300 FAR HILLS AVE STE 300
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-2381
Practice Address - Country:US
Practice Address - Phone:937-433-7536
Practice Address - Fax:937-433-9612
Is Sole Proprietor?:No
Enumeration Date:2015-07-24
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004200363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant