Healthcare Provider Details

I. General information

NPI: 1588111850
Provider Name (Legal Business Name): CHRISTY MICHELLE DOUGHERTY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2016
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10161 US HIGHWAY 70 E
MC EWEN TN
37101-4442
US

IV. Provider business mailing address

180 HILLCREST DR
BRUCETON TN
38317-6524
US

V. Phone/Fax

Practice location:
  • Phone: 931-582-3170
  • Fax: 931-296-7317
Mailing address:
  • Phone: 731-415-2153
  • Fax: 731-499-8175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21488
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: