Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 3007800 | KY |
NPI | 1003248246 |
---|---|
Provider Name | Mrs. Christina Daugherty |
First Address | Lexington, KY 40509-2121 |
Second Address | Lexington, KY 40509-2121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2013 |
Last Update Date | 05/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100260040 | (05) | KY |