Provider Demographics
NPI:1376139360
Name:EUBANKS, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:EUBANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:MOONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6820 PLATTSBURG RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:OH
Mailing Address - Zip Code:45368-8737
Mailing Address - Country:US
Mailing Address - Phone:937-206-9034
Mailing Address - Fax:
Practice Address - Street 1:6820 PLATTSBURG RD
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:OH
Practice Address - Zip Code:45368-8737
Practice Address - Country:US
Practice Address - Phone:937-206-9034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker