Provider Demographics
NPI:1235496191
Name:DUBOSQUE, KARI KRISTIANE (MD)
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:KRISTIANE
Last Name:DUBOSQUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KARI
Other - Middle Name:KRISTIANE
Other - Last Name:ERICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10608 GLENEAGLE PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2667
Mailing Address - Country:US
Mailing Address - Phone:407-462-3361
Mailing Address - Fax:
Practice Address - Street 1:10608 GLENEAGLE PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-2667
Practice Address - Country:US
Practice Address - Phone:407-462-3361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-17
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY474382084P0800X
MN612792084P0800X
ND135602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program