MEDICARE: MRS. COURTNEY LOUISE DUBOSE CPNP-AC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	19743	SC

General Provider Information

NPI Number	:	1225268592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. COURTNEY LOUISE DUBOSE CPNP-AC

Provider Business Mailing Address
First Line	:	2051 CHARLIE HALL BLVD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-5834
Country	:	US
Telephone Number	:	843-737-9467
Fax Number	:	843-371-5507

Provider Business Practice Location Address
First Line	:	1952 LONG GROVE DR
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-7579
Country	:	US
Telephone Number	:	843-971-2992
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2009
Last Update Date	:	07/21/2022

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