Provider Demographics
NPI:1801224753
Name:VICKERS, KRISTEN E (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:E
Last Name:VICKERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:RICHFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05476-1141
Mailing Address - Country:US
Mailing Address - Phone:802-255-5580
Mailing Address - Fax:
Practice Address - Street 1:3 CREST RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-9753
Practice Address - Country:US
Practice Address - Phone:802-524-4554
Practice Address - Fax:802-527-6792
Is Sole Proprietor?:No
Enumeration Date:2013-10-30
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT055.0031185363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant