MEDICARE: KELLY A DOHERTY ARNP

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	363L00000X	Nurse Practitioner	04891221	NH
2	363LF0000X	Family Nurse Practitioner	151176	ME
3	363LF0000X	Family Nurse Practitioner	101.0135067	VT
4	363LF0000X	Family Nurse Practitioner	048912-23	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588642607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY A DOHERTY ARNP

Provider Business Mailing Address
First Line	:	40 SAINT MATTHEWS DR
Second Line	:
City	:	BARRINGTON
State	:	NH
Zip	:	03825-5037
Country	:	US
Telephone Number	:	603-767-0554
Fax Number	:	603-749-2453

Provider Business Practice Location Address
First Line	:	15 CONSTITUTION DR FL 1
Second Line	:
City	:	BEDFORD
State	:	NH
Zip	:	03110-6042
Country	:	US
Telephone Number	:	603-923-9119
Fax Number	:	603-749-2453

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

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	03/24/2022

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