Provider Demographics
NPI:1811990104
Name:PELKEY, PHOEBE (PA-C)
Entity type:Individual
Prefix:MS
First Name:PHOEBE
Middle Name:
Last Name:PELKEY
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 1:372 DORSET ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6212
Mailing Address - Country:US
Mailing Address - Phone:802-660-8808
Mailing Address - Fax:802-660-4310
Practice Address - Street 1:372 DORSET ST
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403
Practice Address - Country:US
Practice Address - Phone:802-660-8808
Practice Address - Fax:802-660-4310
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0550030608363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT59179OtherBLUE SHIELD ID NUMBER
VTP76142Medicare UPIN
AP1864Medicare ID - Type UnspecifiedMEDICARE ID NUMBER