Provider Demographics
NPI:1689429961
Name:DOHERTY, JOSEPH ANDREW JR (APRN-CNP)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ANDREW
Last Name:DOHERTY
Suffix:JR
Gender:M
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2738 ARTIC ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-1104
Mailing Address - Country:US
Mailing Address - Phone:781-385-1350
Mailing Address - Fax:
Practice Address - Street 1:2121 E FLAMINGO RD STE 214
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5124
Practice Address - Country:US
Practice Address - Phone:702-405-9819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV829083363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily