Provider Demographics
NPI:1104841378
Name:HYMAN, TROY DELL (CST/CFA)
Entity type:Individual
Prefix:MR
First Name:TROY
Middle Name:DELL
Last Name:HYMAN
Suffix:
Gender:M
Credentials:CST/CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 IVY FARM CT
Mailing Address - Street 2:
Mailing Address - City:ALVATON
Mailing Address - State:KY
Mailing Address - Zip Code:42122-9691
Mailing Address - Country:US
Mailing Address - Phone:270-843-0829
Mailing Address - Fax:270-782-0564
Practice Address - Street 1:1725 ASHLEY CIR
Practice Address - Street 2:SUITE 211
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3337
Practice Address - Country:US
Practice Address - Phone:270-782-0434
Practice Address - Fax:270-782-0564
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSA054363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical