Healthcare Provider Details

I. General information

NPI: 1548509359
Provider Name (Legal Business Name): SARAH ANN EUBANK APRN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 WATSON ST STE 200
PRATT KS
67124-3092
US

IV. Provider business mailing address

203 WATSON ST STE 200
PRATT KS
67124-3092
US

V. Phone/Fax

Practice location:
  • Phone: 620-672-7422
  • Fax: 620-508-6476
Mailing address:
  • Phone: 620-672-7422
  • Fax: 620-508-6476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-75921-062
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number13-100459-062
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: