Provider Demographics
NPI:1639478324
Name:HUTTON, ASHLEY BLALOCK (PA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:BLALOCK
Last Name:HUTTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:DIANNE
Other - Last Name:BLALOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:4536 BONNEY RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3818
Mailing Address - Country:US
Mailing Address - Phone:757-490-9388
Mailing Address - Fax:757-490-9401
Practice Address - Street 1:736 BATTLEFIELD BLVD N
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4941
Practice Address - Country:US
Practice Address - Phone:757-490-9388
Practice Address - Fax:757-490-9401
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003557363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical