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1063018141 NPI number — HAILY NICOLE HELTON PA

NPI Number: 1063018141
Health Care Provider/Practitioner: HAILY NICOLE HELTON PA

Information about “1063018141” NPI (HAILY NICOLE HELTON PA) exists in 1063018141 in HTML format HTML  |  1063018141 in plain Text format TXT  |  1063018141 in PDF (Portable Document Format) PDF  |  1063018141 in an XML format XML  formats.

NPI Number : 1063018141 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1063018141",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HELTON",
    "FirstName": "HAILY",
    "MiddleName": "NICOLE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "10837 LAUREL ST STE 204",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RANCHO CUCAMONGA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "91730-7657",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "909-294-5358",
    "MailingAddressFaxNumber": "909-294-5356",
    "FirstLinePracticeLocationAddress": "1757 EATON PL",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LA VERNE",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "91750-2681",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "909-709-0621",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/05/2020",
    "LastUpdateDate": "01/13/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": "PA59186",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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