Provider Demographics
NPI:1255653804
Name:WILLBANKS, JUDY MAE
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:MAE
Last Name:WILLBANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:MAE
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ECDT
Mailing Address - Street 1:1910 RECTOR RD
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-2004
Mailing Address - Country:US
Mailing Address - Phone:870-240-8500
Mailing Address - Fax:870-240-8505
Practice Address - Street 1:1910 RECTOR RD
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-2004
Practice Address - Country:US
Practice Address - Phone:870-240-8500
Practice Address - Fax:870-240-8505
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information