Healthcare Provider Details

I. General information

NPI: 1457579500
Provider Name (Legal Business Name): KARI LYNN DICKEY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 MAIN ST.
PUTNEY VT
05346-0247
US

IV. Provider business mailing address

17 BELMONT AVE
BRATTLEBORO VT
05301-7601
US

V. Phone/Fax

Practice location:
  • Phone: 802-387-5581
  • Fax: 802-387-6694
Mailing address:
  • Phone: 802-387-5581
  • Fax: 802-387-6694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1123
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0320075457
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: