Healthcare Provider Details

I. General information

NPI: 1235053497
Provider Name (Legal Business Name): KAYLA JO-MASSENA WALSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRANGER RD
BARRE VT
05641-5369
US

IV. Provider business mailing address

600 GRANGER RD
BARRE VT
05641-5369
US

V. Phone/Fax

Practice location:
  • Phone: 802-223-1878
  • Fax:
Mailing address:
  • Phone: 802-223-1878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number101.0139679
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: