Individual
ALISSA K DAUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4044 FORT CAMPBELL BLVD, PMB# 124, HOPKINSVILLE, KY 42240-4950
(270) 839-2298
(999) 999-9999
Mailing address
4044 FORT CAMPBELL BLVD, PMB# 124, HOPKINSVILLE, KY 42240-4950
(502) 322-5219
(999) 999-9999
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
47177
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100253410
—
KY
Enumeration date
06/05/2012
Last updated
12/19/2018
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