Provider Demographics
NPI:1588111850
Name:DOUGHERTY, CHRISTY MICHELLE (FNP)
Entity type:Individual
Prefix:MS
First Name:CHRISTY
Middle Name:MICHELLE
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:180 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:BRUCETON
Mailing Address - State:TN
Mailing Address - Zip Code:38317-6524
Mailing Address - Country:US
Mailing Address - Phone:731-415-2153
Mailing Address - Fax:731-499-8175
Practice Address - Street 1:10161 US HIGHWAY 70 E
Practice Address - Street 2:
Practice Address - City:MC EWEN
Practice Address - State:TN
Practice Address - Zip Code:37101-4442
Practice Address - Country:US
Practice Address - Phone:931-582-3170
Practice Address - Fax:931-296-7317
Is Sole Proprietor?:No
Enumeration Date:2016-09-05
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21488363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3380640OtherGROUP MEDICAID NUMBER
TN3380640OtherGROUP MEDICARE NUMBER