Provider Demographics
NPI:1679945208
Name:BOYDSTON, HILARY (PA-C)
Entity type:Individual
Prefix:
First Name:HILARY
Middle Name:
Last Name:BOYDSTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HILARY
Other - Middle Name:
Other - Last Name:ELLINGSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:501 WILLARD ST
Mailing Address - Street 2:APT 445
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-3274
Mailing Address - Country:US
Mailing Address - Phone:847-347-5302
Mailing Address - Fax:
Practice Address - Street 1:935 SHOTWELL RD
Practice Address - Street 2:SUITE 108
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-5597
Practice Address - Country:US
Practice Address - Phone:919-550-0821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085005670363A00000X
NC0010-06472363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant