Healthcare Provider Details

I. General information

NPI: 1003248246
Provider Name (Legal Business Name): CHRISTINA DAUGHERTY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2013
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 N EAGLE CREEK DR SUITE 400
LEXINGTON KY
40509-2121
US

IV. Provider business mailing address

160 N EAGLE CREEK DR SUITE 400
LEXINGTON KY
40509-2121
US

V. Phone/Fax

Practice location:
  • Phone: 859-258-5220
  • Fax: 859-258-5405
Mailing address:
  • Phone: 859-258-5220
  • Fax: 859-258-5405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number3007800
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1121772
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1121772
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: