Provider Demographics
NPI:1760004808
Name:BANKS, JASI MARIE (RN)
Entity Type:Individual
Prefix:
First Name:JASI
Middle Name:MARIE
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 1:5621 OLD BULLARD RD APT 161
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-4317
Mailing Address - Country:US
Mailing Address - Phone:903-952-0109
Mailing Address - Fax:
Practice Address - Street 1:5621 OLD BULLARD RD APT 161
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-4317
Practice Address - Country:US
Practice Address - Phone:903-952-0109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX958752163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics