Peter Richard Nobes, PA

Key facts

NPI

1003976630

Entity type

Individual (NPI type 1)

Primary specialty

Medical Physician Assistant 363AM0700X

License

055-0030117 (VT)

Practice address

32 Malletts Bay Ave
Winooski, VT 05404-1959

Phone

(802) 655-4422

Fax

(802) 861-2678

NPI assigned

Dec 12, 2006

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Physician Assistant

State licenses

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 7, 2023.

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1003976630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7702 SPEAR ST",
            "city": "CHARLOTTE",
            "state": "VT",
            "postal_code": "054458221",
            "telephone_number": "802-425-2260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32 MALLETTS BAY AVE",
            "city": "WINOOSKI",
            "state": "VT",
            "postal_code": "054041959",
            "telephone_number": "802-655-4422",
            "fax_number": "802-861-2678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOBES",
        "first_name": "PETER",
        "middle_name": "RICHARD",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-12",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VT",
            "license": "055-0030117",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VT. PHYSICIAN ASSISTANT CERTIFICATE",
            "identifier": "055-0031041",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• William Myregaard, LCMHC
• Dorsey T Naylor, LICSW
• Elena Sergeyevna Nichols, LICSW
• Tyler Patrick O'Bryan, MD
• Bernadette M O'Neil, LICSW,LADC
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• Benjamin M Patno, LCMHC

All providers in Winooski, VT · Medical Physician Assistant in Vermont