Healthcare Provider Details

I. General information

NPI: 1043760721
Provider Name (Legal Business Name): NICOLE KEARNEY ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2016
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 TILLEY DR STE 51
SOUTH BURLINGTON VT
05403-4484
US

IV. Provider business mailing address

185 TILLEY DR STE 51
SOUTH BURLINGTON VT
05403-4484
US

V. Phone/Fax

Practice location:
  • Phone: 802-860-3366
  • Fax:
Mailing address:
  • Phone: 802-860-3366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number175F00000X
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: