Individual
COLLEEN DAUGHERTY
Active
Sole proprietor
Provider details
NPI number
Gender
F
Contact information
Practice address
149 HART ST, 82 MEDICAL GROUP/CREDENTIALS, SHEPPARD AFB, TX 76311-3477
(940) 676-6960
Mailing address
3509 COPPERAS CV, WICHITA FALLS, TX 76310-1121
(940) 692-5446
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
OT3334
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
VAD 000
MILITARY
TX
Enumeration date
01/03/2006
Last updated
07/08/2007
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