Provider Demographics
NPI:1528664562
Name:SARAH DUBOSE, APRN, PLLC
Entity type:Organization
Organization Name:SARAH DUBOSE, APRN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBOSE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:409-729-7900
Mailing Address - Street 1:3220 CENTRAL MALL DR
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-8037
Mailing Address - Country:US
Mailing Address - Phone:409-729-7900
Mailing Address - Fax:409-727-5277
Practice Address - Street 1:3220 CENTRAL MALL DR
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-8037
Practice Address - Country:US
Practice Address - Phone:409-729-7900
Practice Address - Fax:409-727-5277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-06
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP130187OtherTEXAS MEDICAL BOARD