Provider Demographics
NPI:1134100217
Name:DOUGHERTY, KARA MCGILTON (NP)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:MCGILTON
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 GARVINS LN
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-1214
Mailing Address - Country:US
Mailing Address - Phone:304-242-4890
Mailing Address - Fax:
Practice Address - Street 1:58 16TH ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3660
Practice Address - Country:US
Practice Address - Phone:304-232-5725
Practice Address - Fax:304-233-0698
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV54116363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002288Medicaid
WVDONP17711Medicare ID - Type Unspecified
WVQ38383Medicare UPIN