Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 139986 | MO |
N | 363LN0000X | Nurse Practitioner - Neonatal | 45393 | KS |
NPI | 1124101936 |
---|---|
Provider Name | Ms. Jonna L. Dougherty |
First Address | Overland Park, KS 66210-1334 |
Second Address | Kansas City, MO 64111-3220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 08/07/2007 |