Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jacob Dougherty, AGACNP-BC

Individual provider Gerontology Nurse Practitioner · NPI 1821712316

Jacob Dougherty, AGACNP-BC is a Nurse Practitioner in Centerville, Ohio. Graduated from University of Cincinnati College of Medicine in 2022, 4 years ago. Practices with Kettering Independent Medical Group Inc, a 700-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Ohio.

Years since qualifying
4
Trained at
University of Cincinnati College of Medicine
Licensed in
OH
In the registry since
2022

Practice location Address checks out

2400 Miami Valley Dr
Centerville, OH 45459-4774
Phone: (937) 438-2400
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 3095 Dayton Xenia Rd Ste 900, Dayton, OH 45434-4311 — (937) 458-4010

Specialties & licences

Gerontology Nurse Practitioner (primary) Taxonomy 363LG0600X · Licence APRN.CNP.0032076 (OH)

Record details

NPI number1821712316
Entity typeIndividual (Type 1)
GenderMale
Credentials AGACNP-BC
Sole proprietorYes
NPI enumeratedSeptember 28, 2022
Last updated in NPPESMarch 11, 2026
Certification dateMarch 11, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolUNIVERSITY OF CINCINNATI COLLEGE OF MEDICINE
Graduated 2022 (4 years in practice)
Group practice Kettering Independent Medical Group Inc — 700 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Centerville