Provider Demographics
NPI:1124101936
Name:DOUGHERTY, JONNA L (NNP)
Entity type:Individual
Prefix:MS
First Name:JONNA
Middle Name:L
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11613 OAKMONT ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1334
Mailing Address - Country:US
Mailing Address - Phone:913-451-3646
Mailing Address - Fax:913-451-1166
Practice Address - Street 1:4401 WORNALL RD
Practice Address - Street 2:ST. LUKE'S HOSPITAL
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3220
Practice Address - Country:US
Practice Address - Phone:816-932-5626
Practice Address - Fax:816-932-6139
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS45393363LN0000X
MO139986363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal