Provider Demographics
NPI:1669218756
Name:DOHERTY, KRYSTLE LYNNE (ARNP)
Entity type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:LYNNE
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 E WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-4917
Mailing Address - Country:US
Mailing Address - Phone:850-378-5618
Mailing Address - Fax:850-475-4690
Practice Address - Street 1:213 E WRIGHT ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-4917
Practice Address - Country:US
Practice Address - Phone:850-378-5618
Practice Address - Fax:850-475-0690
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11033513363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily