Daugherty and Daugherty Medical Clinic PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

DAUGHERTY AND DAUGHERTY MEDICAL CLINIC PA

Practice address

1409 Braden St
Jacksonville, AR 72076-3720

Phone

(501) 982-0576

Fax

(501) 982-0041

NPI assigned

May 3, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Joe D Daugherty, M.D.

Title

President

Phone

(501) 982-0576

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John Daugherty, M.D.

  • Family Medicine Physician
  • Jacksonville, AR
  • NPI 1124076922
  Medicare reassignment NPD
• Melissa Colleen McCann, APRN

  • Family Nurse Practitioner
  • North Little Rock, AR
  • NPI 1760027130

  Family Medicine

  NPD (past)
• Sue Sullivan, APN

  • Family Nurse Practitioner
  • Jacksonville, AR
  • NPI 1306019708
  NPD (past)

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581033600000",
    "number": "1942268123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1409 WEST BRADEN",
            "city": "JACKSONVILLE",
            "state": "AR",
            "postal_code": "72076",
            "telephone_number": "501-982-0576",
            "fax_number": "501-982-0041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 BRADEN ST",
            "city": "JACKSONVILLE",
            "state": "AR",
            "postal_code": "720763720",
            "telephone_number": "501-982-0576",
            "fax_number": "501-982-0041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAUGHERTY AND DAUGHERTY MEDICAL CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-03",
        "last_updated": "2020-02-07",
        "certification_date": "2020-02-07",
        "status": "A",
        "authorized_official_last_name": "DAUGHERTY",
        "authorized_official_first_name": "JOE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "501-982-0576",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "04D0466369",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104806002",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MCR CLINIC #",
            "identifier": "CS4952",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Caleb Aaron Crow, DDS
• Dillon Cullins
• Patricia Ann Dahlgren, LCSW
• Matthew Dalton, QBHP
• Mary Marlene Darragh, RN
• John Daugherty, M.D.
• Lauren Cynthia Davenport, M.S. CCC-SLP
• Tracie R Davis-Brown, LMSW
• Amanda L Davis, LAC
• Erica E Davis, RN

• Family Medicine Physician in Jacksonville, AR
• Providers in Jacksonville, AR by specialty
• Family Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.