Provider Demographics
NPI:1790189660
Name:BANKS, SHELBY SALLEY (FNP)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:SALLEY
Last Name:BANKS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:GRAHAM
Other - Last Name:SALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10900 W 44TH AVE UNIT 200
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-2742
Mailing Address - Country:US
Mailing Address - Phone:303-993-1330
Mailing Address - Fax:
Practice Address - Street 1:10900 W 44TH AVE UNIT 200
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-2742
Practice Address - Country:US
Practice Address - Phone:303-993-1330
Practice Address - Fax:303-647-3647
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0995592363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily