Provider Demographics
NPI:1730104837
Name:DOUGHERTY, DEBRA S (ARNP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:S
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-0038
Mailing Address - Country:US
Mailing Address - Phone:812-738-4251
Mailing Address - Fax:812-738-7833
Practice Address - Street 1:1263 HOSPITAL DR NW STE 260
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-2174
Practice Address - Country:US
Practice Address - Phone:812-738-4251
Practice Address - Fax:812-738-7833
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9338893363L00000X
IN71001790363L00000X
KY2258P363LW0102X
FL9338893363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
7663234OtherAETNA
IN200404560Medicaid
KY2447974000OtherPASSPORT ADVANTAGE
FLP01420776OtherRR MEDICARE
IN070134OtherSIHO
IN000000381896OtherANTHEM BCBS
KY50006753OtherPASSPORT KY MEDICAID
KY78001427Medicaid
FLY0C29OtherBCBS
IN000000381896OtherANTHEM BCBS
7663234OtherAETNA
FLY0C29OtherBCBS
KY50006753OtherPASSPORT KY MEDICAID
IN412840SSMedicare PIN