Provider Demographics
NPI:1992719132
Name:TURNER, TROY (PA-C)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:TURNER
Suffix:
Gender:M
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 1:3 CREST RD
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-9753
Mailing Address - Country:US
Mailing Address - Phone:802-524-8915
Mailing Address - Fax:802-527-0977
Practice Address - Street 1:3 CREST RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-9753
Practice Address - Country:US
Practice Address - Phone:802-524-8915
Practice Address - Fax:802-527-0977
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0424747363A00000X
VT055-0030893363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200003240AMedicaid
KS042083OtherBCBS PROV. NO.
VT9000365Medicaid
KSP00194745OtherRR MEDCIARE PROV. NO.
KS042083Medicare ID - Type Unspecified
VT9000365Medicaid
VT0005911Medicare PIN