Provider Demographics
NPI:1629430236
Name:DOUGHTY, JENNIFER LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:DOUGHTY
Suffix:
Gender:F
Credentials:LPN
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 2090
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-2090
Mailing Address - Country:US
Mailing Address - Phone:907-756-3226
Mailing Address - Fax:
Practice Address - Street 1:69222 TIPTON AVENUE
Practice Address - Street 2:
Practice Address - City:ANCHOR POINT
Practice Address - State:AK
Practice Address - Zip Code:99556
Practice Address - Country:US
Practice Address - Phone:907-756-3226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNURP6778164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse