Debra S Dougherty, ARNP

Key facts

NPI

1730104837

Entity type

Individual (NPI type 1)

Primary specialty

Nurse Practitioner 363L00000X

License

71001790 (IN)

Practice address

1263 Hospital Dr NW Ste 260
Corydon, IN 47112-2174

Phone

(812) 738-4251

Fax

(812) 738-7833

NPI assigned

Jul 12, 2006

Sex

Female

Sole proprietor

No

Organizations & group practices 4

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

• Harrison County Hospital Internal Medicine Physician · Corydon, IN · NPI 1790892727
  Medicare reassignment NPD IN
• Harrison County Hospital Rural Health Clinic/Center · Corydon, IN · NPI 1700779378
  NPD
• Genesiscare USA of Florida LLC Urology Physician · Venice, FL · NPI 1316127152
  NPD (past)
• Univeristy Urology, PLLC Urology Physician · Louisville, KY · NPI 1508889957
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 21, 2024.

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729468800000",
    "number": "1730104837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 38",
            "city": "CORYDON",
            "state": "IN",
            "postal_code": "471120038",
            "telephone_number": "812-738-4251",
            "fax_number": "812-738-7833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1263 HOSPITAL DR NW STE 260",
            "city": "CORYDON",
            "state": "IN",
            "postal_code": "471122174",
            "telephone_number": "812-738-4251",
            "fax_number": "812-738-7833"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 3rd Ave W",
            "address_2": "Suite 210",
            "address_purpose": "LOCATION",
            "city": "Bradenton",
            "state": "FL",
            "postal_code": "342058626",
            "country_code": "US",
            "telephone_number": "941-792-0340",
            "fax_number": "941-794-2251",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5300 State Road 64 Ste 103",
            "address_purpose": "LOCATION",
            "city": "Georgetown",
            "state": "IN",
            "postal_code": "471229178",
            "country_code": "US",
            "telephone_number": "812-923-6200",
            "fax_number": "812-738-7833",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOUGHERTY",
        "first_name": "DEBRA",
        "middle_name": "S",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-12",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "ARNP9338893",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71001790",
            "primary": true
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "KY",
            "license": "2258P",
            "primary": false
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "FL",
            "license": "9338893",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7663234",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200404560",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT ADVANTAGE",
            "identifier": "2447974000",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01420776",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SIHO",
            "identifier": "070134",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000381896",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT KY MEDICAID",
            "identifier": "50006753",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "78001427",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "Y0C29",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Corydon, IN · Nurse Practitioner in Indiana