Provider Demographics
NPI:1932571957
Name:DAUGHERTY, STEPHANIE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:
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 196
Mailing Address - Street 2:
Mailing Address - City:KANSAS
Mailing Address - State:OK
Mailing Address - Zip Code:74347-0196
Mailing Address - Country:US
Mailing Address - Phone:918-868-2567
Mailing Address - Fax:918-868-5584
Practice Address - Street 1:499 W BOUNDRY
Practice Address - Street 2:
Practice Address - City:KANSAS
Practice Address - State:OK
Practice Address - Zip Code:74347-1662
Practice Address - Country:US
Practice Address - Phone:918-868-2567
Practice Address - Fax:918-868-5584
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)