Provider Demographics
NPI:1275880692
Name:TALOS, ASHTYN N (PA-C)
Entity Type:Individual
Prefix:
First Name:ASHTYN
Middle Name:N
Last Name:TALOS
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:823 N 129TH INFANTRY DR STE 103
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-8347
Mailing Address - Country:US
Mailing Address - Phone:815-729-9527
Mailing Address - Fax:815-729-9530
Practice Address - Street 1:823 N 129TH INFANTRY DR STE 103
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8347
Practice Address - Country:US
Practice Address - Phone:815-729-9527
Practice Address - Fax:815-729-9530
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2022-05-04
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant