Healthcare Provider Details

I. General information

NPI: 1972412872
Provider Name (Legal Business Name): JAN KIRK CARNEY MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 BEAUMONT AVE
BURLINGTON VT
05405-1742
US

IV. Provider business mailing address

89 BEAUMONT AVE
BURLINGTON VT
05405-1742
US

V. Phone/Fax

Practice location:
  • Phone: 802-656-8275
  • Fax:
Mailing address:
  • Phone: 802-656-8275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number042.0007063
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: