Individual
KIERSTIN RENE DAUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5220 NORTHSHORE DR, NORTH LITTLE ROCK, AR 72118-5297
(501) 663-6455
(501) 663-4877
Mailing address
5220 NORTHSHORE DR, NORTH LITTLE ROCK, AR 72118-5297
(501) 663-6455
(501) 663-4877
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA14101
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
284103795
—
AR
Enumeration date
12/11/2020
Last updated
04/01/2025
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