Kathleen Doherty, CRNP

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

SP025239 Issued in PA

Practice address

255 E Grove Street
Clarks Summit, PA 18411

Phone

(570) 209-7878

NPI assigned

Feb 23, 2023

Last updated

Aug 13, 2024By 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)

Not enrolled

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.

• Blondek Center for Pediatric Health & Wellness PC

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  • Dickson City, PA
  • NPI 1275011660
  NPD (past)
• Main Street Pediatrics of Greater Scranton

  • Pediatric Adolescent Medicine Physician
  • Dickson City, PA
  • NPI 1881253011
  NPD (past)

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

{
    "created_epoch": "1677110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723507200000",
    "number": "1629776125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 E GROVE ST",
            "city": "CLARKS SUMMIT",
            "state": "PA",
            "postal_code": "18411",
            "telephone_number": "570-209-7878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 E GROVE STREET",
            "city": "CLARKS SUMMIT",
            "state": "PA",
            "postal_code": "18411",
            "telephone_number": "570-209-7878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOHERTY",
        "first_name": "KATHLEEN",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-23",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "PA",
            "license": "SP025239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Ernest Di Matteo, ED.D
• Tracy Lee Di Mattia, LSW
• Michelle L Dickson, DPT
• Virginia L Dikeman, MA
• Nicole Rene Dixon, PHYSICAL THERAPIST
• Martin Andrew Donahue, PH.D., ATC, LAT
• William Francis Dougherty, PSY.D.
• Romas Dovydaitis, MD
• Dr. Cynthia Edwards-Hawver, Psy.D. and Associates
• Charles Richard Druffner, MD

• Primary Care Nurse Practitioner in Clarks Summit, PA
• Providers in Clarks Summit, PA by specialty
• Primary Care Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2024; 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.