Individual
STEPHANIE DUBOSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1005 MIDWESTERN PKWY, WICHITA FALLS, TX 76302-2211
(940) 322-0771
Mailing address
1005 MIDWESTERN PKWY, WICHITA FALLS, TX 76302-2211
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
16-0014
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111408401
—
TX
05
—
111408402
—
TX
Enumeration date
10/16/2015
Last updated
10/26/2015
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