Individual
KATHLEEN DOUGHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1597 THE GREENS WAY, JACKSONVILLE BEACH, FL 32250-1401
(904) 425-9648
Mailing address
10532 LANTANA LAKES DR N, JACKSONVILLE, FL 32246-4633
(904) 425-9648
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
RN9183201
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1568985406
INSURANCE
FL
Enumeration date
02/14/2022
Last updated
02/14/2022
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