Provider Demographics
NPI:1538790597
Name:HELTON, AMANDA MARIE (APRN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:HELTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:WALZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5230 KY ROUTE 321 STE 4
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-9169
Mailing Address - Country:US
Mailing Address - Phone:606-886-8880
Mailing Address - Fax:606-886-2193
Practice Address - Street 1:5230 KY ROUTE 321 STE 4
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-9169
Practice Address - Country:US
Practice Address - Phone:606-886-8880
Practice Address - Fax:606-886-8628
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014104363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100717550Medicaid