Provider Demographics
NPI:1780195479
Name:DOUGHERTY, SHELBY JEAN (ARNP)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:JEAN
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:JEAN
Other - Last Name:MEREDITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1221 PLEASANT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1424
Mailing Address - Country:US
Mailing Address - Phone:515-282-2921
Mailing Address - Fax:
Practice Address - Street 1:1221 PLEASANT ST STE 100
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1424
Practice Address - Country:US
Practice Address - Phone:515-282-2921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-20
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA137275363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner