Provider Demographics
NPI:1619577640
Name:MIDDLETON, HAYDEN TAYLOR (PA-C)
Entity Type:Individual
Prefix:
First Name:HAYDEN
Middle Name:TAYLOR
Last Name:MIDDLETON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2270 FORD PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-3412
Mailing Address - Country:US
Mailing Address - Phone:651-696-5000
Mailing Address - Fax:
Practice Address - Street 1:2270 FORD PKWY STE 200
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-3412
Practice Address - Country:US
Practice Address - Phone:651-696-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13560363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN390200000XMedicaid
MN390200000XOtherOTHER