Provider Demographics
NPI:1013673441
Name:DOBLER, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:DOBLER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 S PROSPECT ST RM 2127
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-3456
Mailing Address - Country:US
Mailing Address - Phone:802-847-4589
Mailing Address - Fax:802-847-2461
Practice Address - Street 1:1 S PROSPECT ST RM 2127
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-3456
Practice Address - Country:US
Practice Address - Phone:802-847-4589
Practice Address - Fax:802-847-2461
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0134893363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner