Provider Demographics
NPI:1295413250
Name:EUBANKS, KATHRYN FANELL (CMA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:FANELL
Last Name:EUBANKS
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 WILLOW ROCK RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77088-3413
Mailing Address - Country:US
Mailing Address - Phone:832-738-5981
Mailing Address - Fax:
Practice Address - Street 1:1607 WILLOW ROCK RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088-3413
Practice Address - Country:US
Practice Address - Phone:832-738-5981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider