Active NPI
Crystal Sue Dougherty, RN
- Registered Nurse
- Clarksville, TN
National Provider Identifier
1356813265
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 0000228136
- Practice address
- 330 Pageant LN
Clarksville, TN 37040-3854 - Phone
- (931) 648-5747
- NPI assigned
- Dec 18, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 0000228136 | TN | Primary |
Addresses
Primary practice location
330 Pageant LN
Clarksville, TN 37040-3854
Mailing address
144 Sycamore Hill Dr
Clarksville, TN 37042-1779
Phone (714) 732-9787
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0004502325 | Other | TN | FEMA NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0000228136 | TN | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1545091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1545091200000",
"number": "1356813265",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "144 SYCAMORE HILL DR",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370421779",
"telephone_number": "714-732-9787"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "330 PAGEANT LN",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370403854",
"telephone_number": "931-648-5747"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGHERTY",
"first_name": "CRYSTAL",
"middle_name": "SUE",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-12-18",
"last_updated": "2018-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "TN",
"license": "0000228136",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEMA NUMBER",
"identifier": "0004502325",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clarksville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.