Provider Demographics
NPI:1093170169
Name:SKILLIN, KELSEY MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:MARIE
Last Name:SKILLIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:MARIE
Other - Last Name:FOOTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:152 COLBY ST
Mailing Address - Street 2:
Mailing Address - City:COLEBROOK
Mailing Address - State:NH
Mailing Address - Zip Code:03576-3049
Mailing Address - Country:US
Mailing Address - Phone:603-331-0500
Mailing Address - Fax:603-237-8100
Practice Address - Street 1:82 MAPLE ST.
Practice Address - Street 2:
Practice Address - City:ISLAND POND
Practice Address - State:VT
Practice Address - Zip Code:05846
Practice Address - Country:US
Practice Address - Phone:802-723-4300
Practice Address - Fax:802-723-4544
Is Sole Proprietor?:No
Enumeration Date:2015-12-16
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1144363A00000X
VT055.0031438363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant