Healthcare Provider Details

I. General information

NPI: 1073442737
Provider Name (Legal Business Name): WEST RIVER WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 WESTERN AVE
BRATTLEBORO VT
05301-6093
US

IV. Provider business mailing address

57 WESTERN AVE
BRATTLEBORO VT
05301-6093
US

V. Phone/Fax

Practice location:
  • Phone: 802-254-0252
  • Fax: 802-254-0253
Mailing address:
  • Phone: 802-254-0252
  • Fax: 802-254-0253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE BAKER
Title or Position: OPERATIONS MANAGER
Credential: APRN
Phone: 802-254-0252