Individual
MRS. KIRSTIN ALYCE DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AG-ACNP
Contact information
Practice address
51 N 39TH ST, PHILADELPHIA, PA 19104-2640
(215) 662-8000
Mailing address
1028 N PROVIDENCE RD, MEDIA, PA 19063-2101
(610) 659-8921
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
SP031191
PA
363LC0200X
Critical Care Medicine Nurse Practitioner
SP031191
PA
Other
Enumeration date
11/04/2024
Last updated
11/04/2024
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