Basic Information
| Provider Information | |||||||||
| NPI: | 1811990104 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PELKEY | ||||||||
| FirstName: | PHOEBE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | P.A.-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 372 DORSET ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054036212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8026608808 | ||||||||
| FaxNumber: | 8026604310 | ||||||||
| Practice Location | |||||||||
| Address1: | 372 DORSET ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 05403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8026608808 | ||||||||
| FaxNumber: | 8026604310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2005 | ||||||||
| LastUpdateDate: | 06/19/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0550030608 | VT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 59179 | 01 | VT | BLUE SHIELD ID NUMBER | OTHER |