Healthcare Provider Details

I. General information

NPI: 1659036333
Provider Name (Legal Business Name): JAMIE KAZAR PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 MERCHANTS ROW
WILLISTON VT
05495-4476
US

IV. Provider business mailing address

10 FERRY ST STE 302
CONCORD NH
03301-5081
US

V. Phone/Fax

Practice location:
  • Phone: 802-307-1200
  • Fax: 802-307-1201
Mailing address:
  • Phone: 603-333-1471
  • Fax: 603-255-7286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number055.0031592
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: