Kelli Jean Moylan, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

055.0031485 Issued in VT

Practice address

457 Railroad St Ste 2
St Johnsbury, VT 05819-1643

Phone

(802) 633-6351

Fax

(802) 748-0977

NPI assigned

Sep 20, 2016

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

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

Specialty

Physician Assistant

Education

University of Utah School of Medicine, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northern Counties Health Care IncGroup PAC ID 2860300936, 48 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northeastern Vermont Regional Hospital Hospital, Saint Johnsbury, VT, CCN 471303

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kelli.moylan.1@28542.direct.athenahealth.com

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

• Northern Counties Health Care Inc

  • Federally Qualified Health Center (FQHC)
  • St Johnsbury, VT
  • NPI 1649236225
  Medicare reassignment Care Compare group NPD
• Northern Counties Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Newport, VT
  • NPI 1003564931
  NPD
• Northern Counties Health Care

  • Nurse Practitioner
  • St Johnsbury, VT
  • NPI 1609966944
  NPD (past)
• Northern Counties Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • St Johnsbury, VT
  • NPI 1639783095
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Northeastern Vermont Regional Hospital Inc.

  • Primary Care Clinic/Center
  • Lyndonville, VT
  • NPI 1659459428

  Hospital

  Care Compare affiliation
• Northeastern Vermont Regional Hospital Inc.

  • Podiatrist
  • St Johnsbury, VT
  • NPI 1710631635

  Hospital

  Care Compare affiliation
• Northeastern Vermont Regional Hospital, Inc

  • Critical Access Hospital
  • St Johnsbury, VT
  • NPI 1275576704
  Care Compare affiliation

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

{
    "created_epoch": "1474329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696982400000",
    "number": "1144778192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 SHERMAN DR",
            "city": "ST JOHNSBURY",
            "state": "VT",
            "postal_code": "058199811",
            "telephone_number": "850-212-1040",
            "fax_number": "802-748-4540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "457 RAILROAD ST STE 2",
            "city": "ST JOHNSBURY",
            "state": "VT",
            "postal_code": "058191643",
            "telephone_number": "802-633-6351",
            "fax_number": "802-748-0977"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "137 Main St",
            "address_purpose": "LOCATION",
            "city": "Newport",
            "state": "VT",
            "postal_code": "058554415",
            "country_code": "US",
            "telephone_number": "802-995-2412",
            "fax_number": "802-334-7991",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOYLAN",
        "first_name": "KELLI",
        "middle_name": "JEAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-20",
        "last_updated": "2023-10-11",
        "certification_date": "2023-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "UT",
            "license": "10094033-1206",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VT",
            "license": "055.0031485",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Milne-O'Grady, MSW LLC
• Gary H Mitchell, LADC
• Carol Moore-Whitney, MSN, IBCLC
• Ashleigh Moriarty, BCBA, LBA, M.ED
• Samantha Morrigan, MS, LCMHC
• Kathleen M. Mulkern, CNM
• Carmen M Murray
• Lindsey Muzzy Weekes
• Thomas Andrew Myrter, DO
• Mounica B Nayakudugari

• Medical Physician Assistant in St Johnsbury, VT
• Providers in St Johnsbury, 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 Oct 11, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.