Provider Demographics
NPI:1447575162
Name:LAYTON HYDEN, ANGELA (PA)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:LAYTON HYDEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:LAYTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 9101
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-9494
Mailing Address - Country:US
Mailing Address - Phone:972-745-7500
Mailing Address - Fax:972-745-4336
Practice Address - Street 1:2520 W I 20
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-7280
Practice Address - Country:US
Practice Address - Phone:972-264-5858
Practice Address - Fax:972-264-8800
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01428363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX344219YKPWMedicare PIN