Healthcare Provider Details

I. General information

NPI: 1588642607
Provider Name (Legal Business Name): KELLY A DOHERTY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 CONSTITUTION DR FL 1
BEDFORD NH
03110-6042
US

IV. Provider business mailing address

40 SAINT MATTHEWS DR
BARRINGTON NH
03825-5037
US

V. Phone/Fax

Practice location:
  • Phone: 603-923-9119
  • Fax: 603-749-2453
Mailing address:
  • Phone: 603-767-0554
  • Fax: 603-749-2453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number04891221
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number151176
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0135067
License Number StateVT
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number048912-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: