Individual
KIERAN DOHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814-6051
(208) 625-5200
(208) 625-5201
Mailing address
706 W FRANKLIN ST, SHELTON, WA 98584-2548
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5971256
ID
363A00000X
Physician Assistant
PA61487517
WA
Other
Enumeration date
07/11/2022
Last updated
12/18/2025
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