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General NPI Number Information
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NPI Number | 1760034862
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Entity Type | Individual
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Provider Name | KELLY ANN DOHERTY FNP
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Gender | Female
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Dates
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Enumeration Date | 07/10/2019
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 26300 WOODWARD AVE
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City | ROYAL OAK
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State | MI
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Zip | 48067-0917
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Country | US
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Telephone | 248-336-4000
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Fax | 248-336-9137
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Provider Business Mailing Address
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Address Line | 18000 W 9 MILE RD STE 200
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4020
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Country | US
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Telephone | 248-336-4000
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Fax | 248-336-9137
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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 | 4704300219NSA190JQ
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License Number State | MI
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