Provider Demographics
NPI:1063064020
Name:DOUGHERTY, CAROLINE AMY (FNP)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:AMY
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 DEERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37777-3412
Mailing Address - Country:US
Mailing Address - Phone:865-724-8805
Mailing Address - Fax:
Practice Address - Street 1:3208 DEERFIELD DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:TN
Practice Address - Zip Code:37777-3412
Practice Address - Country:US
Practice Address - Phone:865-724-8805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26135363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily