Basic Information
| Provider Information | |||||||||
| NPI: | 1770014664 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CORBETT | ||||||||
| FirstName: | KAYLA | ||||||||
| MiddleName: | DARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 89 TRESCOTT RD | ||||||||
| Address2: | |||||||||
| City: | ETNA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 037504505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817714587 | ||||||||
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| Practice Location | |||||||||
| Address1: | 111 COLCHESTER AVENUE | ||||||||
| Address2: | UVMMC | ||||||||
| City: | BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 05401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028472345 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2017 | ||||||||
| LastUpdateDate: | 01/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 042-0015038 | VT | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.