Healthcare Provider Details

I. General information

NPI: 1730010927
Provider Name (Legal Business Name): KYLEIGH GRENNON APRN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 MAPLE ST STE 14
MIDDLEBURY VT
05753-1231
US

IV. Provider business mailing address

99 MAPLE ST STE 14
MIDDLEBURY VT
05753-1231
US

V. Phone/Fax

Practice location:
  • Phone: 802-349-1747
  • Fax: 802-419-3670
Mailing address:
  • Phone: 802-349-1747
  • Fax: 802-419-3670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number101.0139400
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: