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MR. TIMOTHY C DOUGHTY CRNA

>> Registered Nurse >> Nursing Service Providers

Registrant NPI Number: 1750314225

Individual Registrant:
MR. TIMOTHY C DOUGHTY CRNA
Gender: M
Sole Proprietor

Location and contact information for practice:
1141 ROSE AVENUE  SELMA, CA 93662-2640 US
Tel: 559-891-1000  Fax: --

Contact information for business:
2420 HOWARD ST  KINGSBURG, CA 93613-2733 US
Tel: 816-585-1850  Fax: --

Registration Information:
NPI: 1750314225
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
N163W00000XNursing Service Providers
Registered Nurse
MO145155
N367500000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Anesthetist, Certified Registered
MO145155
Y367500000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Anesthetist, Certified Registered
CANA3913

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
200305650AKS05
919046300MO05




HEALTH CARE JOBS CA - Page 1



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