Provider Demographics
NPI:1780444331
Name:BANKS, ABBY MAE (RD)
Entity type:Individual
Prefix:MRS
First Name:ABBY
Middle Name:MAE
Last Name:BANKS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3888 SE 56TH ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-1035
Mailing Address - Country:US
Mailing Address - Phone:405-742-8493
Mailing Address - Fax:
Practice Address - Street 1:3888 SE 56TH ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-1035
Practice Address - Country:US
Practice Address - Phone:405-742-8493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1509133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered