Healthcare Provider Details

I. General information

NPI: 1366278988
Provider Name (Legal Business Name): ELIZABETH ADELINE EUBANKS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 HOSPITAL LN STE 202
PERRYVILLE MO
63775-1382
US

IV. Provider business mailing address

206 HOSPITAL LN STE 202
PERRYVILLE MO
63775-1382
US

V. Phone/Fax

Practice location:
  • Phone: 573-768-3396
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: