Provider Demographics
NPI:1619228376
Name:DUBOSE, KALYCA LEYANA (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:KALYCA
Middle Name:LEYANA
Last Name:DUBOSE
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 PAINTERS XING
Mailing Address - Street 2:
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-9631
Mailing Address - Country:US
Mailing Address - Phone:484-574-8036
Mailing Address - Fax:
Practice Address - Street 1:213 REECEVILLE RD
Practice Address - Street 2:SUITE 27
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-1528
Practice Address - Country:US
Practice Address - Phone:610-383-9333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-21
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012373363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care