Individual
KELLI JEAN MOYLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
457 RAILROAD ST STE 2, ST JOHNSBURY, VT 05819-1643
(802) 633-6351
(802) 748-0977
Mailing address
165 SHERMAN DR, ST JOHNSBURY, VT 05819-9811
(850) 212-1040
(802) 748-4540
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
055.0031485
VT
363AM0700X
Medical Physician Assistant
10094033-1206
UT
Other
Enumeration date
09/20/2016
Last updated
10/11/2023
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