Healthcare Provider Details

I. General information

NPI: 1629941554
Provider Name (Legal Business Name): WILLIAM KUNKEL FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2025
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S PROSPECT ST
BURLINGTON VT
05401-5505
US

IV. Provider business mailing address

1 S PROSPECT ST
BURLINGTON VT
05401-5505
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-4696
  • Fax: 802-847-4612
Mailing address:
  • Phone: 802-847-4696
  • Fax: 802-847-4612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number101.0138014
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0138014
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: