Healthcare Provider Details

I. General information

NPI: 1225362932
Provider Name (Legal Business Name): AMY HARRELL BANKS DNP, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY HARRELL CRAVEY NP

II. Dates (important events)

Enumeration Date: 09/28/2009
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 PLAZA AVE STE C
EASTMAN GA
31023-6786
US

IV. Provider business mailing address

911 PLAZA AVE STE C
EASTMAN GA
31023-6786
US

V. Phone/Fax

Practice location:
  • Phone: 478-374-5774
  • Fax: 478-374-9112
Mailing address:
  • Phone: 478-374-5774
  • Fax: 478-374-9112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN123659
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: