Provider Demographics
NPI:1538431390
Name:DUBOSE, TRACIE LEJEUNE (NP)
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:LEJEUNE
Last Name:DUBOSE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 SCHULTZ ROAD
Mailing Address - Street 2:
Mailing Address - City:IOTA
Mailing Address - State:LA
Mailing Address - Zip Code:70543
Mailing Address - Country:US
Mailing Address - Phone:337-230-9280
Mailing Address - Fax:337-457-2203
Practice Address - Street 1:281 MOOSA BLVD
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-3638
Practice Address - Country:US
Practice Address - Phone:337-457-2200
Practice Address - Fax:337-457-2203
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06739363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily