Provider Demographics
NPI:1407516578
Name:DUBOIS, TEVON ANDRE (ARNP)
Entity Type:Individual
Prefix:
First Name:TEVON
Middle Name:ANDRE
Last Name:DUBOIS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3473 WILDES RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:WA
Mailing Address - Zip Code:98236-9309
Mailing Address - Country:US
Mailing Address - Phone:206-551-3587
Mailing Address - Fax:
Practice Address - Street 1:3473 WILDES RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:WA
Practice Address - Zip Code:98236-9309
Practice Address - Country:US
Practice Address - Phone:206-551-3587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2023-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61245713363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health