Individual
JACOB DOUGHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
AGACNP-BC
Contact information
Practice address
2400 MIAMI VALLEY DR, CENTERVILLE, OH 45459-4774
(937) 438-2400
Mailing address
1 PRESTIGE PL STE 550, MIAMISBURG, OH 45342-6115
(937) 762-1306
(937) 522-7017
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
APRN.CNP.0032076
OH
363LG0600X
Gerontology Nurse Practitioner
Primary
APRN.CNP.0032076
OH
Other
Enumeration date
09/28/2022
Last updated
03/11/2026
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