Provider Demographics
NPI:1144730128
Name:HYNES, ASHLEY MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARIE
Last Name:HYNES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 VANDALIA ST
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-4061
Mailing Address - Country:US
Mailing Address - Phone:618-344-0090
Mailing Address - Fax:618-344-4371
Practice Address - Street 1:531 VANDALIA ST
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-4061
Practice Address - Country:US
Practice Address - Phone:618-344-0090
Practice Address - Fax:618-344-4371
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085006349363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant