Provider Demographics
NPI:1629522768
Name:BANKER, HEATHER (APRN, CNM)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BANKER
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 JOE RAMSEY BLVD E STE E
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-7770
Mailing Address - Country:US
Mailing Address - Phone:903-454-1722
Mailing Address - Fax:
Practice Address - Street 1:3900 JOE RAMSEY BLVD E
Practice Address - Street 2:# E
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7727
Practice Address - Country:US
Practice Address - Phone:903-454-1722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131654367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife