Provider Demographics
NPI:1750440517
Name:EUBANKS, KRYSTAL RENEE
Entity type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:RENEE
Last Name:EUBANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 SPRIGGS RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72118-2336
Mailing Address - Country:US
Mailing Address - Phone:501-733-1483
Mailing Address - Fax:
Practice Address - Street 1:510 SPRIGGS RD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72118-2336
Practice Address - Country:US
Practice Address - Phone:501-733-1483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2051225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR160499721Medicaid
AR5Y915OtherBLUE CROSS BLUE SHIELD