Provider Demographics
NPI:1801866975
Name:DUBOIS, PAMELA S (APN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660A S TRUMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-2235
Mailing Address - Country:US
Mailing Address - Phone:636-931-3800
Mailing Address - Fax:636-931-3911
Practice Address - Street 1:660A S TRUMAN BLVD
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2235
Practice Address - Country:US
Practice Address - Phone:636-931-3800
Practice Address - Fax:636-931-3911
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012015199363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR159046758Medicaid
AR159046758Medicaid