Provider Demographics
NPI:1194246595
Name:DUBOSE, ADRIA CHAMPAGNE (NP)
Entity type:Individual
Prefix:MRS
First Name:ADRIA
Middle Name:CHAMPAGNE
Last Name:DUBOSE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:337-470-4881
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:4809 AMBASSADOR CAFFERY PKWY STE 410
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-8802
Practice Address - Country:US
Practice Address - Phone:337-470-4881
Practice Address - Fax:337-470-4882
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAAP09437363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily