Lisa Dubose, RN

Primary specialty

Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X

License

R032817 Issued in AR

Practice address

350 Salem Rd Ste 1
Conway, AR 72034-6166

Phone

(501) 336-8300

Fax

(501) 329-5508

NPI assigned

May 19, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1463616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588204800000",
    "number": "1316394364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 S 48TH ST",
            "city": "SPRINGDALE",
            "state": "AR",
            "postal_code": "727626683",
            "telephone_number": "479-750-2020",
            "fax_number": "479-750-4843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 SALEM RD STE 1",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720346166",
            "telephone_number": "501-336-8300",
            "fax_number": "501-329-5508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUBOSE",
        "first_name": "LISA",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-19",
        "last_updated": "2020-04-30",
        "certification_date": "2020-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "AR",
            "license": "R032817",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "224468795",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marissa Leann Dreher
• Anna Drinkwitz, PT
• Summer Druhan
• Straisley Alexandra Dubois, COTA/L
• Jeffrey Dubose, MHPP
• Theodore W Duensing, DO
• Makenlee Dufresne
• Caroline Claire Duggan
• Lori Dunaway
• Sharon L D Dunaway, MSW

• Psychiatric/Mental Health Registered Nurse in Conway, AR
• Providers in Conway, AR by specialty
• Psychiatric/Mental Health Registered Nurse in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.