Provider Demographics
NPI:1003251919
Name:DAUGHERTY, RACHAEL NICHOLE (APN/NP)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:NICHOLE
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:APN/NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SAINT VINCENT CIR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5405
Mailing Address - Country:US
Mailing Address - Phone:501-552-4777
Mailing Address - Fax:501-552-4482
Practice Address - Street 1:1 SAINT VINCENT CIR
Practice Address - Street 2:SUITE 210
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5405
Practice Address - Country:US
Practice Address - Phone:501-552-4777
Practice Address - Fax:501-552-4482
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003861363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR199226758Medicaid
AR293943Medicare PIN