Healthcare Provider Details

I. General information

NPI: 1184248437
Provider Name (Legal Business Name): CATHERINE EUBANK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2614 FORUM BLVD STE 100
COLUMBIA MO
65203-5431
US

IV. Provider business mailing address

9473 ERIKA LN
NEW BLOOMFIELD MO
65063-1941
US

V. Phone/Fax

Practice location:
  • Phone: 573-445-5366
  • Fax: 573-313-3571
Mailing address:
  • Phone: 314-600-0264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-02496
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2023028228
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: