Individual
DENETRIUS BANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1502 S COLORADO ST, GREENVILLE, MS 38703-7219
(662) 335-4105
Mailing address
1502 S COLORADO ST, GREENVILLE, MS 38703-7219
(662) 335-4105
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
906735
MS
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
906735
MS
Other
Enumeration date
06/20/2024
Last updated
01/23/2025
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