Provider Demographics
NPI:1558601211
Name:BANKS, CHRISTOPHER WAYNE (FNP)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:WAYNE
Last Name:BANKS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 RAINBOW DR # 8624
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77399
Mailing Address - Country:US
Mailing Address - Phone:832-447-8341
Mailing Address - Fax:
Practice Address - Street 1:1057 12TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2509
Practice Address - Country:US
Practice Address - Phone:360-636-3892
Practice Address - Fax:360-414-1342
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-18
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX653079363LF0000X
WAAP61044179363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily