Provider Demographics
NPI:1467808998
Name:BANKS, BETTY JEAN (RN)
Entity Type:Individual
Prefix:MS
First Name:BETTY
Middle Name:JEAN
Last Name:BANKS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 REVERE WAY
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35475-4442
Mailing Address - Country:US
Mailing Address - Phone:205-270-8975
Mailing Address - Fax:
Practice Address - Street 1:4611 REVERE WAY
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35475-4442
Practice Address - Country:US
Practice Address - Phone:205-270-8975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1095922163W00000X
CA628843163W00000X
FL9206249163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1095922Medicaid
AL1095922OtherMEDICARE PROVIDER