Jacqueline Catney Dubois, MD
Individual provider Active NPI Pediatrics Physician · Jacksonville, TX
NPI 1043206147 · NPPES record last updated Nov 21, 2024
Key facts
- NPI
- 1043206147
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- L0145 (TX)
- Practice address
- 510 E Commerce St
Jacksonville, TX 75766-4910 - Phone
- (903) 535-9041
- NPI assigned
- Sep 23, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 7
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051012000813 | TX | Practitioner - Pediatric Medicine | 4587689146 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0432450 | KS | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tyler Family Circle of Care | Current |
Accepting new patients | |
| Tyler Family Circle of Care | Current |
Accepting new patients | |
| Suncoast Medical Group Inc | Past | Accepting new patients | |
| Nuch of Texas | Past | Accepting new patients | |
| Dallas County Mental Health & Mental Retardation Center | Past | Accepting new patients | |
| Southwest Doctors PA | Past | Accepting new patients | |
| TMH Physician Associates PLLC | Past | Accepting new patients |
Locations
1001 N Palestine St
Athens, TX 75751
Phone (903) 904-5084
510 E Commerce St
Jacksonville, TX 75766
Phone (903) 541-2700
523 S Fannin Ave
Tyler, TX 75702
214 E Houston St
Tyler, TX 75702
Phone (903) 593-1892
2990 N Broadway Ave
Tyler, TX 75702
Phone (903) 245-1984
Interoperability endpoints
- jdubois207937@christushealth.direct-ci.net
- https://api.platform.athenahealth.com/4066/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 0432450 | KS | |
| Pediatrics Physician | 208000000X | L0145 | TX | Yes |
Addresses
Primary practice location
510 E Commerce St
Jacksonville, TX 75766-4910
Mailing address
523 S Fannin Ave
Tyler, TX 75702-8204
Phone (903) 535-9041
Other providers in Jacksonville, TX
- Dental Zone PLLC
- Timothy B Different
- Tiffany Ann Dodson
- Dogwood Orthopaedic Clinic, PA
- Jasmine Dominique Douglas
- Deborah Dubose
- Roxanne D. Dudley
- Callie Elizabeth Dunkerson
- Mikayle Anne Durant
- Ryan Earle
All providers in Jacksonville, TX · Pediatrics Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 21, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.