MEDICARE: ASHLEY DOUGHERTY LM, CPM

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	176B00000X	Midwife

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0	OTHER		0

General Provider Information

NPI Number	:	1538824123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY DOUGHERTY LM, CPM

Provider Business Mailing Address
First Line	:	2328 S 102ND EAST AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74129-4637
Country	:	US
Telephone Number	:	918-855-3556
Fax Number	:

Provider Business Practice Location Address
First Line	:	2328 S 102ND EAST AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74129-4637
Country	:	US
Telephone Number	:	918-855-3556
Fax Number	:

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

Provider Enumeration Date	:	11/08/2021
Last Update Date	:	11/08/2021

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