Provider Demographics
NPI:1356962047
Name:DOUGHERTY, JAYME (FNP-C)
Entity type:Individual
Prefix:
First Name:JAYME
Middle Name:
Last Name:DOUGHERTY
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 1:2974 140TH ST
Mailing Address - Street 2:
Mailing Address - City:BELMOND
Mailing Address - State:IA
Mailing Address - Zip Code:50421-7505
Mailing Address - Country:US
Mailing Address - Phone:515-571-9930
Mailing Address - Fax:
Practice Address - Street 1:403 1ST ST SE
Practice Address - Street 2:
Practice Address - City:BELMOND
Practice Address - State:IA
Practice Address - Zip Code:50421-1201
Practice Address - Country:US
Practice Address - Phone:641-444-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA158559363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily