Provider Demographics
NPI:1609369586
Name:WILBANKS, VICTORIA HAVENS (FNP)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:HAVENS
Last Name:WILBANKS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 EUREKA ST STE A
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-2533
Mailing Address - Country:US
Mailing Address - Phone:662-563-6000
Mailing Address - Fax:662-563-2200
Practice Address - Street 1:107 EUREKA ST STE A
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-2533
Practice Address - Country:US
Practice Address - Phone:662-563-6000
Practice Address - Fax:662-563-2200
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902725363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily