Provider Demographics
NPI:1326544289
Name:EUBANKS, HOLLY LUCAS (NP)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:LUCAS
Last Name:EUBANKS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:19 OCEAN DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-3666
Mailing Address - Country:US
Mailing Address - Phone:252-802-0617
Mailing Address - Fax:
Practice Address - Street 1:3850 ED DR STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8037
Practice Address - Country:US
Practice Address - Phone:919-788-9588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-31
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF03180961207Q00000X
NC5010467363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1326544289Medicaid