Active NPI
Kathleen Manns
- Pediatric Nurse Practitioner
- St Johnsbury, VT
National Provider Identifier
1760421093
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 1010010350
- Practice address
- 97 Sherman Dr
St. Johnsbury Pediatrics
St Johnsbury, VT 05819-9280 - Phone
- (802) 748-5131
- Fax
- (802) 748-4237
- NPI assigned
- Jun 5, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 1010010350 | VT | Primary |
Addresses
Primary practice location
97 Sherman Dr
St. Johnsbury Pediatrics
St Johnsbury, VT 05819-9280
Mailing address
97 Sherman Drive
St. Johnsbury, VT 05819
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1005218 | Medicaid | VT | |
| 30008265 | Medicaid | NH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1010010350 | VT | MD | Pediatric Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149465600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1332374400000",
"number": "1760421093",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "97 SHERMAN DRIVE",
"city": "ST. JOHNSBURY",
"state": "VT",
"postal_code": "05819"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "97 SHERMAN DR",
"address_2": "ST. JOHNSBURY PEDIATRICS",
"city": "ST JOHNSBURY",
"state": "VT",
"postal_code": "058199280",
"telephone_number": "802-748-5131",
"fax_number": "802-748-4237"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANNS",
"first_name": "KATHLEEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-05",
"last_updated": "2012-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "VT",
"license": "1010010350",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1005218",
"state": "VT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30008265",
"state": "NH"
}
],
"endpoints": [],
"other_names": []
}Other providers in St Johnsbury, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.