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Individual
LISA KELLEY
Active
Individual
LISA KELLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
C.N.M.
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
101-0014084
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00059280
BCBS
VT
05
—
1009149
—
VT
01
—
361683
MVP
VT
01
—
5207602
VERMONT MANAGED CARE
VT
Enumeration date
12/29/2005
Last updated
08/13/2010
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