Healthcare Provider Details

I. General information

NPI: 1568703684
Provider Name (Legal Business Name): JESSICA KARAM EUBANKS AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 N ELM ST
GREENSBORO NC
27401-1005
US

IV. Provider business mailing address

1309 N ELM ST
GREENSBORO NC
27401-1005
US

V. Phone/Fax

Practice location:
  • Phone: 336-544-5400
  • Fax: 336-544-5401
Mailing address:
  • Phone: 336-544-5400
  • Fax: 336-544-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5006104
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: