Provider Demographics
NPI:1922070747
Name:HELTON, CAMILLA ELIZABETH (PA)
Entity Type:Individual
Prefix:
First Name:CAMILLA
Middle Name:ELIZABETH
Last Name:HELTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CAMILLA
Other - Middle Name:E
Other - Last Name:HALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-893-2440
Mailing Address - Fax:336-893-2470
Practice Address - Street 1:7114 VILLAGE MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8004
Practice Address - Country:US
Practice Address - Phone:336-893-2440
Practice Address - Fax:336-893-2470
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0001-03063363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC5260AOtherMEDICARE PTAN
NC2753007AOtherMEDICARE PTAN
NCNC5260BOtherMEDICARE PTAN
NC1285682310OtherWSCA GRP NPI #
NCNC5260AOtherMEDICARE PTAN