Healthcare Provider Details

I. General information

NPI: 1821553371
Provider Name (Legal Business Name): NIKKI HELTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2019
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5607 DICKENSON HWY
CLINTWOOD VA
24228-7009
US

IV. Provider business mailing address

5607 DICKENSON HWY
CLINTWOOD VA
24228-7009
US

V. Phone/Fax

Practice location:
  • Phone: 276-926-4601
  • Fax: 276-926-4602
Mailing address:
  • Phone: 276-926-4601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024177268
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: