Provider Demographics
NPI:1699205559
Name:DAUGHENBAUGH, KERISSA M (APRN)
Entity Type:Individual
Prefix:
First Name:KERISSA
Middle Name:M
Last Name:DAUGHENBAUGH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KERISSA
Other - Middle Name:E
Other - Last Name:MCKINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:234 W PORTER STREET
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42261
Mailing Address - Country:US
Mailing Address - Phone:270-526-9652
Mailing Address - Fax:
Practice Address - Street 1:234 W PORTER STREET
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:KY
Practice Address - Zip Code:42261
Practice Address - Country:US
Practice Address - Phone:270-526-9652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011386363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily