Provider Demographics
NPI:1538824123
Name:DOUGHERTY, ASHLEY (LM, CPM)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2328 S 102ND EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-4637
Mailing Address - Country:US
Mailing Address - Phone:918-855-3556
Mailing Address - Fax:
Practice Address - Street 1:2328 S 102ND EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-4637
Practice Address - Country:US
Practice Address - Phone:918-855-3556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
0Other0