Provider Demographics
NPI:1699332379
Name:EUBANKS, KRISTINA MARIE (MS CF-SLP)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIE
Last Name:EUBANKS
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 LONESOME OAK LOOP
Mailing Address - Street 2:
Mailing Address - City:HENSLEY
Mailing Address - State:AR
Mailing Address - Zip Code:72065-9529
Mailing Address - Country:US
Mailing Address - Phone:501-722-7110
Mailing Address - Fax:
Practice Address - Street 1:9209 DOLLARWAY RD
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:AR
Practice Address - Zip Code:71602-2616
Practice Address - Country:US
Practice Address - Phone:870-247-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR200525235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR200525OtherAR PROVISIONAL LICENSE