Provider Demographics
NPI:1811338130
Name:HESTER, AVYNNE (PA)
Entity type:Individual
Prefix:MS
First Name:AVYNNE
Middle Name:
Last Name:HESTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2559 AMBER ST APT 209
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-1768
Mailing Address - Country:US
Mailing Address - Phone:732-682-0668
Mailing Address - Fax:
Practice Address - Street 1:1701 JOHN TIPTON BLVD
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08110-1405
Practice Address - Country:US
Practice Address - Phone:856-406-4755
Practice Address - Fax:856-662-2316
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00198800363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant