Provider Demographics
NPI:1295700821
Name:FELDER, KATHY G (WHNP-BC, CUNP)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:G
Last Name:FELDER
Suffix:
Gender:F
Credentials:WHNP-BC, CUNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 RIDGEWOOD RD
Mailing Address - Street 2:LEVEL C
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156-3060
Mailing Address - Country:US
Mailing Address - Phone:802-886-3556
Mailing Address - Fax:
Practice Address - Street 1:29 RIDGEWOOD RD
Practice Address - Street 2:C
Practice Address - City:SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05156-3060
Practice Address - Country:US
Practice Address - Phone:802-886-3556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1010012159363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010012159OtherSTATE LIC
VT1008527Medicaid
S58489Medicare UPIN
VTNP118801Medicare PIN