Provider Demographics
NPI:1477374031
Name:BANKS, TRACY P
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:P
Last Name:BANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 BARNEY BANKS RD
Mailing Address - Street 2:
Mailing Address - City:PINOLA
Mailing Address - State:MS
Mailing Address - Zip Code:39149-3132
Mailing Address - Country:US
Mailing Address - Phone:601-968-7876
Mailing Address - Fax:
Practice Address - Street 1:273 BARNEY BANKS RD
Practice Address - Street 2:
Practice Address - City:PINOLA
Practice Address - State:MS
Practice Address - Zip Code:39149-3132
Practice Address - Country:US
Practice Address - Phone:601-968-7876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS338687164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse