Healthcare Provider Details

I. General information

NPI: 1750951364
Provider Name (Legal Business Name): DEBORAH DOUGHERTY FNP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2021
Last Update Date: 06/26/2021
Certification Date: 06/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5821 STAPLES MILL RD
RICHMOND VA
23228-5427
US

IV. Provider business mailing address

5821 STAPLES MILL RD
RICHMOND VA
23228-5427
US

V. Phone/Fax

Practice location:
  • Phone: 804-264-0966
  • Fax:
Mailing address:
  • Phone: 804-264-0966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBORAH DOUGHERTY
Title or Position: NURSE PRACTITIONER
Credential: MSN, FNP
Phone: 585-315-6441