Candis Joan Cousins, PAC
Individual provider Active NPI Physician Assistant · South Burlington, VT
NPI 1831207166 · NPPES record last updated Feb 7, 2011
Key facts
- NPI
- 1831207166
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 550030284 (VT)
- Practice address
- 364 Dorset St
Ste 2
South Burlington, VT 05403-6270 - Phone
- (802) 859-9500
- NPI assigned
- Aug 28, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 550030284 | VT | MD | Physician Assistant |
| 001880 | NY | MD | Advanced Practice Midwife |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lake Champlain Gynecologic Oncology, PC | Physician Assistant | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 550030284 | VT | Yes |
Addresses
Primary practice location
364 Dorset St
Ste 2
South Burlington, VT 05403-6270
Mailing address
123 Hanley Lane
Jericho, VT 05465
Phone (802) 899-9960
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 08V151 | Other | MVP | |
| 2000061 | Medicaid | VT |
Other providers in South Burlington, VT
- Tiffany Cook
- Suzanne Grantham Corbitt
- Richard Cordero
- Kristi Cornforth
- Leah McLane Costello
- Dominique J Couture-Sherman
- Jeffrey Allen Crandall
- Evan Hayden Crandell
- Grace Samantha Crawford
- Shelley Ann Crombach
All providers in South Burlington, VT · Physician Assistant in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 7, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.