Provider Demographics
NPI:1083072219
Name:DUBOSE, SARAH (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:DUBOSE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 CENTRAL MALL DR
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-8037
Mailing Address - Country:US
Mailing Address - Phone:409-729-7900
Mailing Address - Fax:409-727-5277
Practice Address - Street 1:3320 CENTRAL MALL DRIVE
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8037
Practice Address - Country:US
Practice Address - Phone:409-729-7900
Practice Address - Fax:409-727-5277
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130187363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily