Healthcare Provider Details

I. General information

NPI: 1538824123
Provider Name (Legal Business Name): ASHLEY DOUGHERTY LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2328 S 102ND EAST AVE
TULSA OK
74129-4637
US

IV. Provider business mailing address

2328 S 102ND EAST AVE
TULSA OK
74129-4637
US

V. Phone/Fax

Practice location:
  • Phone: 918-855-3556
  • Fax:
Mailing address:
  • Phone: 918-855-3556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: