Basic Information
| Provider Information | |||||||||
| NPI: | 1669136248 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EUBANK | ||||||||
| FirstName: | SHERRY | ||||||||
| MiddleName: | FRANKLIN | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 854 MULBERRY AVE | ||||||||
| Address2: | |||||||||
| City: | SELMER | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383752334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316461781 | ||||||||
| FaxNumber: | 7316461786 | ||||||||
| Practice Location | |||||||||
| Address1: | 854 MULBERRY AVE | ||||||||
| Address2: | |||||||||
| City: | SELMER | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383752334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316461781 | ||||||||
| FaxNumber: | 7316461786 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2021 | ||||||||
| LastUpdateDate: | 01/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 904852 | MS | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 30875 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.