MEDICARE: MS. CHRISTY MICHELLE DOUGHERTY FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	21488	TN

General Provider Information

NPI Number	:	1588111850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTY MICHELLE DOUGHERTY FNP

Provider Business Mailing Address
First Line	:	180 HILLCREST DR
Second Line	:
City	:	BRUCETON
State	:	TN
Zip	:	38317-6524
Country	:	US
Telephone Number	:	731-415-2153
Fax Number	:	731-499-8175

Provider Business Practice Location Address
First Line	:	10161 US HIGHWAY 70 E
Second Line	:
City	:	MC EWEN
State	:	TN
Zip	:	37101-4442
Country	:	US
Telephone Number	:	931-582-3170
Fax Number	:	931-296-7317

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2016
Last Update Date	:	09/26/2022

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