Healthcare Provider Details

I. General information

NPI: 1740126747
Provider Name (Legal Business Name): JENICE ANGELLE DUBARD PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14323 RED LODGE TRL
CONROE TX
77384-2297
US

IV. Provider business mailing address

14323 RED LODGE TRL
CONROE TX
77384-2297
US

V. Phone/Fax

Practice location:
  • Phone: 877-814-1782
  • Fax:
Mailing address:
  • Phone: 877-814-1782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1247083
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: