Provider Demographics
NPI:1982717716
Name:EUBANKS, LORI (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:EUBANKS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71052-2603
Mailing Address - Country:US
Mailing Address - Phone:318-872-2700
Mailing Address - Fax:318-872-6214
Practice Address - Street 1:130 JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:LA
Practice Address - Zip Code:71052
Practice Address - Country:US
Practice Address - Phone:318-872-2700
Practice Address - Fax:318-872-6214
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN086440AP04340207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1179892Medicaid
Q07590Medicare UPIN
4C959Medicare ID - Type Unspecified