Provider Demographics
NPI:1063018141
Name:HELTON, HAILY NICOLE
Entity Type:Individual
Prefix:
First Name:HAILY
Middle Name:NICOLE
Last Name:HELTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9804 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3616
Mailing Address - Country:US
Mailing Address - Phone:909-466-5433
Mailing Address - Fax:
Practice Address - Street 1:9804 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3616
Practice Address - Country:US
Practice Address - Phone:909-466-5433
Practice Address - Fax:909-466-5499
Is Sole Proprietor?:No
Enumeration Date:2020-12-05
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant