Individual
MICHELLE BANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2080 S FRONTAGE RD, SUITE T, VICKSBURG, MS 39180-5328
(601) 262-1000
(601) 262-1009
Mailing address
2080 S FRONTAGE RD, SUITE T, VICKSBURG, MS 39180-5328
(601) 262-1000
(601) 262-1009
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R805638
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00121754
—
MS
Enumeration date
06/19/2006
Last updated
09/17/2008
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