Provider Demographics
NPI:1447658307
Name:DOUGHERTY, KATHERINE LOUISE (PA-C)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:LOUISE
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1510 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-3308
Mailing Address - Country:US
Mailing Address - Phone:830-816-4357
Mailing Address - Fax:830-331-8718
Practice Address - Street 1:212 US HIGHWAY 87
Practice Address - Street 2:
Practice Address - City:COMFORT
Practice Address - State:TX
Practice Address - Zip Code:78013-3705
Practice Address - Country:US
Practice Address - Phone:830-995-3887
Practice Address - Fax:830-995-3393
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2016-06-22
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8977NMOtherBC PIN
TXP01529987OtherRR MEDICARE PTAN
TXP01529987OtherRR MEDICARE PTAN