Individual
MIRA DAUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
430 W MAIN ST, DANVILLE, KY 40422-1888
(502) 219-3488
Mailing address
307 DALLAS DR, HUSTONVILLE, KY 40437-8304
(606) 669-0537
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
3012025
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100522600
—
KY
Enumeration date
03/05/2018
Last updated
11/11/2021
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