Provider Demographics
NPI:1174248165
Name:DOHERTY, TERRY LYNN (NP)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:LYNN
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:298 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-3119
Mailing Address - Country:US
Mailing Address - Phone:339-793-3154
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST # 1500
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-3874
Practice Address - Fax:617-643-1384
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAG07220221363LA2200X
MARN161828363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health