Healthcare Provider Details

I. General information

NPI: 1689491003
Provider Name (Legal Business Name): TINA ASHLEY BANKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 OLD HIGHWAY 3
EDWARDS MS
39066-9207
US

IV. Provider business mailing address

2120 OLD HIGHWAY 3
EDWARDS MS
39066-9207
US

V. Phone/Fax

Practice location:
  • Phone: 601-953-8577
  • Fax:
Mailing address:
  • Phone: 601-953-8577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: