Healthcare Provider Details

I. General information

NPI: 1952072258
Provider Name (Legal Business Name): NICHOLAS DEAN HELTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2021
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 N STATE OF FRANKLIN RD
JOHNSON CITY TN
37604-6034
US

IV. Provider business mailing address

509 MED TECH PKWY STE 100
JOHNSON CITY TN
37604-2579
US

V. Phone/Fax

Practice location:
  • Phone: 423-431-7111
  • Fax: 423-431-7092
Mailing address:
  • Phone: 423-302-6565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number30146
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: