Provider Demographics
NPI:1235814922
Name:DOUGHTY, KARSYN LYNN
Entity Type:Individual
Prefix:
First Name:KARSYN
Middle Name:LYNN
Last Name:DOUGHTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 OAKES AVE
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-4819
Mailing Address - Country:US
Mailing Address - Phone:715-415-6829
Mailing Address - Fax:
Practice Address - Street 1:2616 OAKES AVE
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-4819
Practice Address - Country:US
Practice Address - Phone:715-415-6829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program