Healthcare Provider Details

I. General information

NPI: 1730104837
Provider Name (Legal Business Name): DEBRA S DOUGHERTY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1263 HOSPITAL DR NW STE 260
CORYDON IN
47112-2174
US

IV. Provider business mailing address

PO BOX 38
CORYDON IN
47112-0038
US

V. Phone/Fax

Practice location:
  • Phone: 812-738-4251
  • Fax: 812-738-7833
Mailing address:
  • Phone: 812-738-4251
  • Fax: 812-738-7833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9338893
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71001790
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2258P
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number9338893
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: