Provider Demographics
NPI:1891918397
Name:DUBOIS, JACALYN (MED)
Entity Type:Individual
Prefix:
First Name:JACALYN
Middle Name:
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SPIRAL DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1351
Mailing Address - Country:US
Mailing Address - Phone:859-525-1128
Mailing Address - Fax:859-525-0351
Practice Address - Street 1:31 SPIRAL DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1351
Practice Address - Country:US
Practice Address - Phone:859-525-1128
Practice Address - Fax:859-525-0351
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist