Provider Demographics
NPI:1710445119
Name:MCNEILL, HAYDEN BOYD (PA-C)
Entity Type:Individual
Prefix:
First Name:HAYDEN
Middle Name:BOYD
Last Name:MCNEILL
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 1:1802 28TH AVE N
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77590-4134
Mailing Address - Country:US
Mailing Address - Phone:409-750-2250
Mailing Address - Fax:
Practice Address - Street 1:17376 NORTHWEST FWY
Practice Address - Street 2:
Practice Address - City:JERSEY VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:77040-1114
Practice Address - Country:US
Practice Address - Phone:832-919-8484
Practice Address - Fax:832-919-8446
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTEMPORARY363A00000X, 390200000X
TXPA12705363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1161319OtherNCCPA ID
TXPA12705OtherLICENSE NUMBER