Provider Demographics
NPI:1396566535
Name:KRAMER, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:KRAMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 FRENCH ST
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-4231
Mailing Address - Country:US
Mailing Address - Phone:802-279-9196
Mailing Address - Fax:802-728-4197
Practice Address - Street 1:11 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:VT
Practice Address - Zip Code:05060-1126
Practice Address - Country:US
Practice Address - Phone:802-728-4466
Practice Address - Fax:802-728-4197
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker