Provider Demographics
NPI:1700864220
Name:DUBOIS, LINDA CHERYL (CRNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:CHERYL
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1887
Mailing Address - Street 2:1401 WOODSTOCK AVE
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36202-1887
Mailing Address - Country:US
Mailing Address - Phone:256-237-0215
Mailing Address - Fax:256-237-0295
Practice Address - Street 1:1401 WOODSTOCK AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-3947
Practice Address - Country:US
Practice Address - Phone:256-237-0215
Practice Address - Fax:256-237-0295
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-082088363LG0600X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51509640DUBOtherBCBS
AL891012650Medicaid
AL529929680Medicaid
AL891012650Medicaid
AL051551382Medicare ID - Type Unspecified