Healthcare Provider Details

I. General information

NPI: 1174991590
Provider Name (Legal Business Name): JACQUELINE DOBY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-0001
US

IV. Provider business mailing address

MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-0001
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-0664
  • Fax: 336-716-5537
Mailing address:
  • Phone: 336-716-0664
  • Fax: 336-716-5537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5012698
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: