Provider Demographics
NPI:1619636834
Name:RAFFERTY, KELSEY (CAA)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:RAFFERTY
Suffix:
Gender:F
Credentials:CAA
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:ATNIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAA
Mailing Address - Street 1:1035 DOCKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-6703
Mailing Address - Country:US
Mailing Address - Phone:920-264-2992
Mailing Address - Fax:
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:WEST PAVILION, LEVEL 2
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-2415
Practice Address - Fax:802-847-5324
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT135.0000094367H00000X
367H00000X
VT135.0000096-SEC367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant