Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | R206176 | MD |
N | 363LA2200X | Nurse Practitioner - Adult Health | R206176 | MD |
N | 363LG0600X | Nurse Practitioner - Gerontology | R206176 | MD |
N | 363LP2300X | Nurse Practitioner - Primary Care | R206176 | MD |
NPI | 1043605389 |
---|---|
Provider Name | Ms. Kristin Leigh Doherty |
First Address | Baltimore, MD 21218 |
Second Address | Baltimore, MD 21218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2015 |
Last Update Date | 19/12/2018 |