Provider Demographics
NPI:1457579500
Name:DICKEY, KARI LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:KARI
Middle Name:LYNN
Last Name:DICKEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-7601
Mailing Address - Country:US
Mailing Address - Phone:802-387-5581
Mailing Address - Fax:802-387-6694
Practice Address - Street 1:79 MAIN ST.
Practice Address - Street 2:
Practice Address - City:PUTNEY
Practice Address - State:VT
Practice Address - Zip Code:05346-0247
Practice Address - Country:US
Practice Address - Phone:802-387-5581
Practice Address - Fax:802-387-6694
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1123207Q00000X
VT0320075457207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30229123Medicaid
SCRHC013Medicaid
SCGP0365Medicaid
VT1019056Medicaid
NH30229123Medicaid
SC423820Medicare Oscar/Certification
VT1019056Medicaid