Carol Daugherty, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

615134 Issued in CO

Practice address

1726 S Prairie Ave
Pueblo, CO 81005-2253

Phone

(719) 561-1291

Fax

(719) 561-8660

NPI assigned

Apr 24, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Colorado State University Pueblo

  dba Wolfpack Wellness Center

  • Family Nurse Practitioner
  • Pueblo, CO
  • NPI 1467225730
  NPD
• Family Medicine of Pueblo PLLC

  • Family Medicine Physician
  • Pueblo, CO
  • NPI 1912995929
  NPD (past)
• Prairie Medical Clinic PLLC

  • Family Medicine Physician
  • Pueblo, CO
  • NPI 1891914693
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1346469061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1726 S PRAIRIE AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810052253",
            "telephone_number": "719-561-1291",
            "fax_number": "719-561-8660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1726 S PRAIRIE AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810052253",
            "telephone_number": "719-561-1291",
            "fax_number": "719-561-8660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAUGHERTY",
        "first_name": "CAROL",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CO",
            "license": "615134",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joscilyn Jo Daniel
• Tyler Daniels
• Kenneth D Danylchuk, MD, PH.D.
• Melissa Dasher
• Linda Mariw Dati, L.M.S.W.
• Paul Daugherty, PTA
• Penny Daugherty
• Ronald D. Daurio, DDS
• Charul A Dave, OTR
• Callie Davidson, NURSE PRACTITIONER

• Nurse Practitioner in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Nurse Practitioner in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.