Patricia Logan McKibben, RD, CD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

0740000157 Issued in VT

Practice address

111 Colchester Ave
Burlington, VT 05401-1473

Phone

(802) 847-3640

NPI assigned

Apr 20, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VT

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• University of Vermont Medical Center Inc

  dba Uvm Medical Center

  • Internal Medicine Physician
  • Burlington, VT
  • NPI 1659309615
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1023235835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 DEACONS WAY",
            "city": "WATERBURY CENTER",
            "state": "VT",
            "postal_code": "056778111",
            "telephone_number": "802-244-7647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 COLCHESTER AVE",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054011473",
            "telephone_number": "802-847-3640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKIBBEN",
        "first_name": "PATRICIA",
        "middle_name": "LOGAN",
        "name_prefix": "Mrs.",
        "credential": "RD, CD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "VT",
            "license": "0740000157",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "0740000157",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Micum Kyle McIntire, MS, ATC, OTC
• Catherine L McIsaac, RD
• Rebecca McKay
• Stacey A McKenna, AA
• Erin Katherine McKenney
• Wendy Clare McKinnon, M.S.
• Kevin McKivergan, LCMHC
• Brittni McKolosky, BCBA
• Mark D McLane, LICSW
• Ashley M McLaren, DNP, AGNP-C

• Registered Dietitian in Burlington, VT
• Providers in Burlington, VT by specialty
• Registered Dietitian in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.