Provider Demographics
NPI:1346905957
Name:BANKS, JESSICA RENEE (RD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENEE
Last Name:BANKS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 POLK AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6034
Mailing Address - Country:US
Mailing Address - Phone:901-289-3946
Mailing Address - Fax:
Practice Address - Street 1:3933 ALLENBROOKE CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-1866
Practice Address - Country:US
Practice Address - Phone:901-795-2444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3784133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered