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NPI Code Detail

MEDICARE: KELLY JILL DOUGHERTY MD

MEDICARE: KELLY JILL DOUGHERTY MD
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
1207Q00000XFamily Medicine Physician2025001431MO

General Provider Information

NPI Number : 1376282764
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY JILL DOUGHERTY MD
Provider Business Mailing Address
First Line : 1275 N TRUMAN BLVD
Second Line :
City : FESTUS
State : MO
Zip : 63028-1176
Country : US
Telephone Number : 636-267-0600
Fax Number : 636-465-9512
Provider Business Practice Location Address
First Line : 1275 N TRUMAN BLVD
Second Line :
City : FESTUS
State : MO
Zip : 63028-1176
Country : US
Telephone Number : 844-853-8937
Fax Number : 636-465-9512
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2022
Last Update Date : 10/31/2025

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Directions to “ KELLY JILL DOUGHERTY MD” Practice Location

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