Provider Demographics
NPI:1932190659
Name:HINTON, KELLY J (PA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:HINTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:1 HEALTHY WAY
Mailing Address - Street 2:ATTN PHYSICIAN BILLING DEPT
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-1551
Mailing Address - Country:US
Mailing Address - Phone:516-632-3000
Mailing Address - Fax:
Practice Address - Street 1:1 HEALTHY WAY
Practice Address - Street 2:ATTN PHYSICIAN BILLING DEPT
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-1551
Practice Address - Country:US
Practice Address - Phone:516-632-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY006422-1363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP18884Medicare UPIN
NY5402L1Medicare PIN