Individual
SARA DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
7302 S BINGHAM JUNCTION BLVD, MIDVALE, UT 84047-4804
(801) 442-5502
Mailing address
7302 S BINGHAM JUNCTION BLVD, MIDVALE, UT 84047-4804
(801) 442-5502
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
120828
MO
363LF0000X
Family Nurse Practitioner
Primary
10814308-4405
UT
363LF0000X
Family Nurse Practitioner
APRN002108
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100183120A
—
OK
01
—
173861
ANTHEM
MO
01
—
1821024480
SMA MEDICAID
NV
05
—
200000240A
—
KS
05
—
428623219
—
MO
01
—
500014122
RR MEDICARE
—
01
—
V112696
SMA MEDICARE
NV
Enumeration date
06/24/2006
Last updated
12/26/2018
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