Provider Demographics
NPI:1861626228
Name:HILSTON, JACQUELYNE S (PA-C)
Entity Type:Individual
Prefix:
First Name:JACQUELYNE
Middle Name:S
Last Name:HILSTON
Suffix:
Gender:F
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 1:1339 S FEDERAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-4235
Mailing Address - Country:US
Mailing Address - Phone:303-602-0000
Mailing Address - Fax:
Practice Address - Street 1:6255 QUEBEC PKWY
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-4812
Practice Address - Country:US
Practice Address - Phone:303-286-8900
Practice Address - Fax:303-286-4970
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52979363A00000X
CO4918363A00000X
COPA.0004918363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant