Provider Demographics
NPI:1568963908
Name:DUBOSE, COURTNEY RENEE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:RENEE
Last Name:DUBOSE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:COURTNEY
Other - Middle Name:RENEE
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1211 S GLOSTER ST STE A
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6548
Mailing Address - Country:US
Mailing Address - Phone:662-767-4200
Mailing Address - Fax:662-767-4204
Practice Address - Street 1:1500 MILITARY ST S STE 11
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:AL
Practice Address - Zip Code:35570-5050
Practice Address - Country:US
Practice Address - Phone:662-767-4200
Practice Address - Fax:662-767-4204
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-172358207X00000X, 363LF0000X
MS902512363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery