Healthcare Provider Details

I. General information

NPI: 1720932023
Provider Name (Legal Business Name): COLLEEN RAE FISK PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 BELMONT AVE
BRATTLEBORO VT
05301-6614
US

IV. Provider business mailing address

63 BELMONT AVE
BRATTLEBORO VT
05301-6614
US

V. Phone/Fax

Practice location:
  • Phone: 802-251-8764
  • Fax: 802-254-9211
Mailing address:
  • Phone: 802-251-8764
  • Fax: 802-254-9211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number101.0138151
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: