Provider Demographics
NPI:1215253018
Name:DAUGHERTY, TERRI SUSAN (RN)
Entity type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:SUSAN
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5237 BRINDLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRODHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40409-8452
Mailing Address - Country:US
Mailing Address - Phone:859-986-1259
Mailing Address - Fax:
Practice Address - Street 1:209 PAULINE DR
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-8889
Practice Address - Country:US
Practice Address - Phone:859-986-1259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1035141163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management