Provider Demographics
NPI:1427590405
Name:LUCY, KATELYN MARY (CNM)
Entity Type:Individual
Prefix:MS
First Name:KATELYN
Middle Name:MARY
Last Name:LUCY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:115 FROST ST
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-6530
Mailing Address - Country:US
Mailing Address - Phone:802-681-8303
Mailing Address - Fax:
Practice Address - Street 1:21 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-7110
Practice Address - Country:US
Practice Address - Phone:802-251-9965
Practice Address - Fax:802-251-9972
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
367A00000X
VT101.0125383363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife