Provider Demographics
NPI:1902215460
Name:DUBERVILLE, JEFFRIE LYN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JEFFRIE
Middle Name:LYN
Last Name:DUBERVILLE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JEFFRIE
Other - Middle Name:PERKINS
Other - Last Name:DUBERVILLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:1765 LAWTON DR
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70665-8611
Mailing Address - Country:US
Mailing Address - Phone:337-764-4628
Mailing Address - Fax:
Practice Address - Street 1:1765 LAWTON DR
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70665-8611
Practice Address - Country:US
Practice Address - Phone:337-764-4628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-10
Last Update Date:2015-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07974363LF0000X
TX128195363LF0000X
NM02736363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily