Basic Information
Provider Information
NPI: 1548482102
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PIERCE
FirstName: KRISTEN
MiddleName: KELLY
NamePrefix: MS.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 111 COLCHESTER AVE
Address2: FLETCHER ALLEN HEALTH CARE
City: BURLINGTON
State: VT
PostalCode: 054011473
CountryCode: US
TelephoneNumber: 8028473819
FaxNumber:  
Practice Location
Address1: 111 COLCHESTER AVENUE
Address2: FLETCHER ALLEN HEALTH CARE
City: BURLINGTON
State: VT
PostalCode: 05401
CountryCode: US
TelephoneNumber: 8028472700
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/03/2007
LastUpdateDate: 02/28/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RI0200X042-0011597VTY Allopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease

No ID Information.


Home