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General NPI Number Information
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NPI Number | 1083387369
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Entity Type | Individual
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Provider Name | KATELYNN GENEVIEVE DOUGHERTY SOPER DNP, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/01/2021
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Last Update Date | 08/01/2021
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Provider Practice Location Address
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Address Line | 227 SAINT PAUL ST
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City | BALTIMORE
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State | MD
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Zip | 21202-2001
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Country | US
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Telephone | 410-783-5858
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Fax |
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Provider Business Mailing Address
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Address Line | 13 PATCHWORK CT
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City | MONKTON
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State | MD
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Zip | 21111-1604
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Country | US
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Telephone | 443-829-9609
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R192850
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License Number State | MD
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