Individual
JAMIE L KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
111 COLCHESTER AVE, ACCMP2, BURLINGTON, VT 05401-1473
(802) 847-0000
Mailing address
111 COLCHESTER AVE, ACCMP2, BURLINGTON, VT 05401-1473
(802) 847-0000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
055-0031104
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
276456
MEDICARE ID-TYPE UNSPECIFIED
VT
Enumeration date
05/06/2006
Last updated
06/17/2011
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