Provider Demographics
NPI:1649378613
Name:HELTSLEY, JOHN
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:HELTSLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 786
Mailing Address - Street 2:1620 SOUTH MAIN ST
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42241
Mailing Address - Country:US
Mailing Address - Phone:270-886-6316
Mailing Address - Fax:270-886-6323
Practice Address - Street 1:1620 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1990
Practice Address - Country:US
Practice Address - Phone:270-886-6316
Practice Address - Fax:270-886-6323
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1265DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77902294Medicaid
KY000000051763OtherANTHEM
KY77012659Medicaid
U50294Medicare UPIN
KY3886460001Medicare NSC
KY9238Medicare ID - Type Unspecified
KY77902294Medicaid