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Individual

KELLY ELI DAUGHERTY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
2200 NW 26TH ST, OWATONNA, MN 55060-5503
(507) 451-1120
Mailing address
2200 NW 26TH ST, OWATONNA, MN 55060-5503
(507) 451-1120

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12173
MN
363A00000X
Physician Assistant
363AS0400X
Surgical Physician Assistant
PAC0622
ND

Other

Enumeration date
12/09/2015
Last updated
02/09/2024
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