Provider Demographics
NPI:1023085594
Name:HULIN, CLAYT W (PA-C)
Entity type:Individual
Prefix:
First Name:CLAYT
Middle Name:W
Last Name:HULIN
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 1:1309 DUCHAMP RD
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-7603
Mailing Address - Country:US
Mailing Address - Phone:337-852-9530
Mailing Address - Fax:
Practice Address - Street 1:1309 DUCHAMP RD
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518-7603
Practice Address - Country:US
Practice Address - Phone:337-852-9530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA10411363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P48022Medicare UPIN
LA5CC16P433Medicare ID - Type Unspecified