Provider Demographics
NPI:1306059910
Name:NORTON, KATIE LYN (PA-C)
Entity type:Individual
Prefix:MS
First Name:KATIE
Middle Name:LYN
Last Name:NORTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 COLCHESTER AVE., BAIRD 1
Mailing Address - Street 2:FLETCHER ALLEN HEALTH CARE
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401
Mailing Address - Country:US
Mailing Address - Phone:802-847-5222
Mailing Address - Fax:802-847-4817
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:BAIRD 196
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-5222
Practice Address - Fax:802-847-4817
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0550031024363AS0400X
MDC0003504363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT9000456Medicaid
NY03288373Medicaid