Provider Demographics
NPI:1952318297
Name:EBERHART, MARY H (WHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:H
Last Name:EBERHART
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8700 US HIGHWAY 380
Mailing Address - Street 2:STE 300
Mailing Address - City:CROSSROADS
Mailing Address - State:TX
Mailing Address - Zip Code:76227-2661
Mailing Address - Country:US
Mailing Address - Phone:940-365-9001
Mailing Address - Fax:940-365-9009
Practice Address - Street 1:8700 US HIGHWAY 380
Practice Address - Street 2:STE 300
Practice Address - City:CROSSROADS
Practice Address - State:TX
Practice Address - Zip Code:76227-2661
Practice Address - Country:US
Practice Address - Phone:940-365-9001
Practice Address - Fax:940-365-9009
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX518137363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX341119101Medicaid
TX365982Medicare PIN