Healthcare Provider Details

I. General information

NPI: 1154284875
Provider Name (Legal Business Name): KATELYN ROCHE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 BUSHNELL RD
WAITSFIELD VT
05673-7208
US

IV. Provider business mailing address

PO BOX 1381
WAITSFIELD VT
05673-1381
US

V. Phone/Fax

Practice location:
  • Phone: 802-341-0937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number026.0084434
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: