Provider Demographics
NPI:1588143002
Name:HELMHOLT, JENNIFER (AGACNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HELMHOLT
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:SOBIERALSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1216 SIMEON DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-3548
Mailing Address - Country:US
Mailing Address - Phone:618-250-0690
Mailing Address - Fax:
Practice Address - Street 1:200 HEALTH CARE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:IL
Practice Address - Zip Code:62246-1154
Practice Address - Country:US
Practice Address - Phone:618-664-1230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041374967163W00000X
IL209017993363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse