MEDICARE: MS. ANGELA DOUGHERTY CNS

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	364SA2100X	Acute Care Clinical Nurse Specialist	APN.0004988-CNS	CO
2	364SA2200X	Adult Health Clinical Nurse Specialist	APN.0004988-CNS	CO
3	363LF0000X	Family Nurse Practitioner	APN.1000607-NP	CO
4	364SC0200X	Critical Care Medicine Clinical Nurse Specialist	116443	CO

General Provider Information

NPI Number	:	1386013340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELA DOUGHERTY CNS

Provider Business Mailing Address
First Line	:	EVANS ARMY HOSPITAL
Second Line	:	1650 COCHRAN CIRCLE
City	:	FORT CARSON
State	:	CO
Zip	:	80913
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1650 COCHRANE CIR
Second Line	:
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4613
Country	:	US
Telephone Number	:	719-526-7000
Fax Number	:

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

Provider Enumeration Date	:	09/21/2015
Last Update Date	:	01/20/2026

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