Provider Demographics
NPI:1316136039
Name:EUBANKS, BETH S (NP)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:S
Last Name:EUBANKS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-606-6400
Mailing Address - Fax:903-606-1522
Practice Address - Street 1:3311 PRESCOTT RD
Practice Address - Street 2:SUITE 112
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3900
Practice Address - Country:US
Practice Address - Phone:318-767-3346
Practice Address - Fax:318-767-3357
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2023-12-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LAAP05310363L00000X
LA088939363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1021041Medicaid
LA3A453Medicare PIN