Provider Demographics
NPI:1790439313
Name:DAUGHERTY, SHIRLEY (FNP-C)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 N VIENNA WOODS DR
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-2069
Mailing Address - Country:US
Mailing Address - Phone:765-215-7965
Mailing Address - Fax:
Practice Address - Street 1:3505 N VIENNA WOODS DR
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-2069
Practice Address - Country:US
Practice Address - Phone:765-215-7965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0030655363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner