Provider Demographics
NPI:1053330324
Name:DOUGHERTY, KARA (DNP, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:KARA
Middle Name:
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 STATE HIGHWAY 176 E
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:MO
Mailing Address - Zip Code:65754-9425
Mailing Address - Country:US
Mailing Address - Phone:214-335-5244
Mailing Address - Fax:
Practice Address - Street 1:317 6TH AVE STE 400
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-4108
Practice Address - Country:US
Practice Address - Phone:515-612-9839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013000290363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153505602Medicaid
TX8K5921Medicare PIN
MO151170142Medicare UPIN
TX153505602Medicaid