Provider Demographics
NPI:1487657128
Name:HELTON, KATHLEEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:J
Last Name:HELTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 DANNY THOMAS PL
Mailing Address - Street 2:MS 515
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-3678
Mailing Address - Country:US
Mailing Address - Phone:901-595-3006
Mailing Address - Fax:901-595-3842
Practice Address - Street 1:262 DANNY THOMAS PL
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-3678
Practice Address - Country:US
Practice Address - Phone:901-595-3006
Practice Address - Fax:901-595-3842
Is Sole Proprietor?:No
Enumeration Date:2005-05-26
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN284462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0528091Medicaid
MI104689616Medicaid
AZ799223Medicaid
TN3809244Medicaid
ME422400000Medicaid
NC7612284Medicaid
MS00120351Medicaid
NE100249677-00Medicaid
KY64929540Medicaid
KS100448900AMedicaid
AL009913760Medicaid
LA1429678Medicaid
AR136349001Medicaid
NJ0030694Medicaid
MT0078523Medicaid
CO07176538Medicaid
MO205081003Medicaid
NE100249677-00Medicaid
AR136349001Medicaid