Individual
DECEMBER L DAUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
200 HAWTHORNE LN, CHARLOTTE, NC 28204-2515
(704) 384-6478
(704) 384-8222
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-6478
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5004447
NC
363LF0000X
Family Nurse Practitioner
5004447
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285865576
—
NC
01
—
5004447
NURSE PRACTITIONER
NC
05
—
QNP081
—
SC
Enumeration date
08/04/2009
Last updated
05/02/2019
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