Provider Demographics
NPI:1144258062
Name:DAUGHERTY, VALENTENIA (DPM)
Entity type:Individual
Prefix:DR
First Name:VALENTENIA
Middle Name:
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18921 G E VALLEY VIEW PKWY
Mailing Address - Street 2:#226
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-7024
Mailing Address - Country:US
Mailing Address - Phone:816-795-9098
Mailing Address - Fax:816-795-7156
Practice Address - Street 1:18921 G E VALLEY VIEW PKWY
Practice Address - Street 2:#226
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-7012
Practice Address - Country:US
Practice Address - Phone:816-795-9098
Practice Address - Fax:816-795-7156
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO000658213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO303158406Medicaid
MO18016015OtherBCBS PROVIDER NUMBER
1144258062OtherNPI
MOU26522Medicare UPIN
MO303158406Medicaid