Provider Demographics
NPI:1497179956
Name:HELTON, ERIC GENTRY (APRN)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:GENTRY
Last Name:HELTON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-2746
Mailing Address - Country:US
Mailing Address - Phone:606-528-9700
Mailing Address - Fax:606-528-8423
Practice Address - Street 1:57 SUMMIT DR
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2746
Practice Address - Country:US
Practice Address - Phone:606-528-9700
Practice Address - Fax:606-528-8423
Is Sole Proprietor?:No
Enumeration Date:2014-02-04
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008489363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100276910Medicaid
KY7100276910Medicaid