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General NPI Number Information
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NPI Number | 1891518320
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Entity Type | Individual
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Provider Name | KIRSTIN ALYCE DOUGHERTY AG-ACNP
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Gender | Female
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Dates
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Enumeration Date | 11/04/2024
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 51 N 39TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19104-2640
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Country | US
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Telephone | 215-662-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 1028 N PROVIDENCE RD
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City | MEDIA
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State | PA
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Zip | 19063-2101
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Country | US
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Telephone | 610-659-8921
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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 | 363LC0200X
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Taxonomy Name | Critical Care Medicine Nurse Practitioner
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License Number | SP031191
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | SP031191
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License Number State | PA
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