Provider Demographics
NPI:1326157512
Name:DAUGHERTY, LAURA B (NP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:B
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-4612
Mailing Address - Country:US
Mailing Address - Phone:704-986-3900
Mailing Address - Fax:704-986-3913
Practice Address - Street 1:232 CONCORD RD
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-4612
Practice Address - Country:US
Practice Address - Phone:704-986-3900
Practice Address - Fax:704-986-3913
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC130316363LW0102X
NC5000691363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8971913Medicaid
NCF65162Medicare UPIN
NC2227656BMedicare ID - Type Unspecified