Individual
ERIN COLLEEN WILLBANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
2400 NW 24TH ST, FORT WORTH, TX 76106-6629
(817) 569-5401
(817) 569-5042
Mailing address
2400 NW 24TH ST, FORT WORTH, TX 76106-6629
(817) 569-5401
(817) 569-5042
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
730109
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
288430604
—
TX
01
—
288430605
CSHCN MEDICAID
TX
01
—
8N0217
BLUE CROSS BLUE SHIELD
TX
Enumeration date
11/21/2011
Last updated
07/18/2014
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