Provider Demographics
NPI:1669449278
Name:FINCH, KERRY BRENNAN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:BRENNAN
Last Name:FINCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KERRY
Other - Middle Name:ANN
Other - Last Name:BRENNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:69 ALLEN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4564
Mailing Address - Country:US
Mailing Address - Phone:802-775-3314
Mailing Address - Fax:802-775-9617
Practice Address - Street 1:69 ALLEN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4564
Practice Address - Country:US
Practice Address - Phone:802-775-3314
Practice Address - Fax:802-775-9617
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT055-0030761363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTBR-AP2594Medicare ID - Type Unspecified
VTQ63808Medicare UPIN