Individual
CRYSTAL SUE DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
330 PAGEANT LN, CLARKSVILLE, TN 37040-3854
(931) 648-5747
Mailing address
144 SYCAMORE HILL DR, CLARKSVILLE, TN 37042-1779
(714) 732-9787
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
0000228136
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004502325
FEMA NUMBER
TN
Enumeration date
12/18/2018
Last updated
12/18/2018
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