Healthcare Provider Details

I. General information

NPI: 1225493232
Provider Name (Legal Business Name): CAROL MOORE-WHITNEY MSN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2015
Last Update Date: 01/24/2026
Certification Date: 01/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 HOSPITAL DR NORTHEASTERN VERMONT REGIONAL HOSPITAL
ST. JOHNSBURY VT
05819-9962
US

IV. Provider business mailing address

1315 HOSPITAL DR NVRH,
ST. JOHNSBURY VT
05819
US

V. Phone/Fax

Practice location:
  • Phone: 802-748-7333
  • Fax:
Mailing address:
  • Phone: 802-748-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0138407
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number101.0138407
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number026.0017838
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: