Individual
KATHLEEN DOHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
255 E GROVE STREET, CLARKS SUMMIT, PA 18411
(570) 209-7878
Mailing address
255 E GROVE ST, CLARKS SUMMIT, PA 18411
(570) 209-7878
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
SP025239
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1295736742
—
PA
Enumeration date
02/23/2023
Last updated
08/13/2024
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