Kristen Katharina Ely, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

055.0031410 Issued in VT

Practice address

555 Washington Hwy
Morrisville, VT 05661

Phone

(802) 760-6291

NPI assigned

Dec 10, 2018

Last updated

Dec 7, 2021By 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 2

Addresses

Other names 1

• Kristen Katharina Glick Former name

Medicare fee-for-service enrollment

Enrolled in VT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Copley Hospital, Inc.

  • Critical Access Hospital
  • Morrisville, VT
  • NPI 1568414365
  NPD (past)

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

{
    "created_epoch": "1544400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638835200000",
    "number": "1043781552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 WASHINGTON HWY",
            "city": "MORRISVILLE",
            "state": "VT",
            "postal_code": "056618972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 WASHINGTON HWY",
            "city": "MORRISVILLE",
            "state": "VT",
            "postal_code": "05661",
            "telephone_number": "802-760-6291"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "528 Washington Hwy",
            "address_purpose": "LOCATION",
            "city": "Morrisville",
            "state": "VT",
            "postal_code": "056618973",
            "country_code": "US",
            "telephone_number": "802-888-8888",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELY",
        "first_name": "KRISTEN",
        "middle_name": "KATHARINA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-10",
        "last_updated": "2021-12-07",
        "certification_date": "2021-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VT",
            "license": "055.0031410",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VT",
            "license": "055.0031410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTEN",
            "last_name": "GLICK",
            "middle_name": "KATHARINA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Donald English Dupuis, M.D.
• Alexandra Duquette, RD, CD
• Matthew S. E. Ebert, DMD
• Laurie A Ellam, APRN-PMHNP -BC
• Margaret G Elmer, LICSW
• Ernest D. Lapierre, M.S., L.L.C (Dr. Ernest D. Lapierre)
• Nicole Ernst, PA-C
• Richard T Farrell, LICSW
• Celeste Fetter, APRN
• Caitlin G Finigan

• Medical Physician Assistant in Morrisville, VT
• Providers in Morrisville, VT by specialty
• Medical Physician Assistant in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.