Provider Demographics
NPI:1750658621
Name:HELTON, JONATHAN SCOTT (FNP-BC, APRN)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:SCOTT
Last Name:HELTON
Suffix:
Gender:M
Credentials:FNP-BC, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-1511
Mailing Address - Country:US
Mailing Address - Phone:606-233-8140
Mailing Address - Fax:
Practice Address - Street 1:625 MEMORIAL DR STE 1
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-1380
Practice Address - Country:US
Practice Address - Phone:606-435-0001
Practice Address - Fax:606-435-0086
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007238363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100200180Medicaid
KYP01137425OtherRR MEDICARE PTAN
KY3007238OtherKY LICENSE #
KYK035620Medicare PIN