Healthcare Provider Details

I. General information

NPI: 1063758258
Provider Name (Legal Business Name): SCHELERIA BANKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2012
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 GREENFIELD WAY
MADISON MS
39110-8108
US

IV. Provider business mailing address

113 GREENFIELD WAY
MADISON MS
39110-8108
US

V. Phone/Fax

Practice location:
  • Phone: 601-955-2596
  • Fax:
Mailing address:
  • Phone: 601-955-2596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR882851
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: