| Lisa Kelley, CNM | |
|
1775 Williston Rd, Suite 220, South Burlington, VT 05403-6491 | |
| (802) 861-0200 | |
| (802) 861-0210 |
| Full Name | Lisa Kelley |
|---|---|
| Gender | Female |
| Speciality | Advanced Practice Midwife |
| Location | 1775 Williston Rd, South Burlington, Vermont |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447237516 | NPI | - | NPPES |
| 361683 | Other | VT | MVP |
| 5207602 | Other | VT | VERMONT MANAGED CARE |
| 00059280 | Other | VT | BCBS |
| 1009149 | Medicaid | VT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 367A00000X | Advanced Practice Midwife | 101-0014084 (Vermont) | Primary |
| Entity Name | Vermont Gynecology Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1174830251 PECOS PAC ID: 0244428357 Enrollment ID: O20101215001181 |
| Mailing Address | Practice Location Address |
|---|---|
| Lisa Kelley, CNM 66 Bartlett Bay Rd, South Burlington, VT 05403-7737 Ph: (802) 777-8997 | Lisa Kelley, CNM 1775 Williston Rd, Suite 220, South Burlington, VT 05403-6491 Ph: (802) 861-0200 |
Emily Ruth Gates Olson, CNM Advanced Practice Midwife Medicare: Medicare Enrolled Practice Location: 185 Tilley Dr Ste 57, South Burlington, VT 05403 Phone: 802-862-7338 | |
Leah Starr, Advanced Practice Midwife Medicare: Not Enrolled in Medicare Practice Location: 185 Tilley Dr, South Burlington, VT 05403 Phone: 802-862-7338 Fax: 802-862-8411 |