MEDICARE: DR. KIMBERLY ANN DOUGHERTY PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	CAPSY10076	CA

General Provider Information

NPI Number	:	1285773572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY ANN DOUGHERTY PHD

Provider Business Mailing Address
First Line	:	5151 N PALM AVE
Second Line	:	#890
City	:	FRESNO
State	:	CA
Zip	:	93704-2208
Country	:	US
Telephone Number	:	559-225-8960
Fax Number	:	559-225-8901

Provider Business Practice Location Address
First Line	:	5151 N PALM AVE
Second Line	:	#890
City	:	FRESNO
State	:	CA
Zip	:	93704-2208
Country	:	US
Telephone Number	:	559-225-8960
Fax Number	:	559-225-8901

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/08/2007

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