Provider Demographics
NPI:1881607158
Name:HELVESTON, WENDELL R (MD)
Entity type:Individual
Prefix:
First Name:WENDELL
Middle Name:R
Last Name:HELVESTON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 N STATE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2413
Mailing Address - Country:US
Mailing Address - Phone:601-345-4525
Mailing Address - Fax:601-345-4535
Practice Address - Street 1:1190 N STATE ST STE 300
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2413
Practice Address - Country:US
Practice Address - Phone:601-345-4525
Practice Address - Fax:601-345-4535
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS131812084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00116737Medicaid
130013523OtherRAILROAD MEDICARE
MS640507572ALOtherAMERICAN ADMINI GROUP
AL009800800Medicaid
AL009800800Medicaid
MS00116737Medicaid