Provider Demographics
NPI:1790881084
Name:GRIFFIN, KIM MARIE (CNM)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:MARIE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201
Mailing Address - Country:US
Mailing Address - Phone:802-447-2677
Mailing Address - Fax:802-447-7710
Practice Address - Street 1:140 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 306
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201
Practice Address - Country:US
Practice Address - Phone:802-447-2677
Practice Address - Fax:802-447-7710
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0019815367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1006601Medicaid