Healthcare Provider Details

I. General information

NPI: 1386130466
Provider Name (Legal Business Name): CHRISTOPHER CORY WILBANKS DNP, APRN, FNP, CNL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 POPLAR AVE STE 18
MEMPHIS TN
38111
US

IV. Provider business mailing address

3445 POPLAR AVE STE 18
MEMPHIS TN
38111-4667
US

V. Phone/Fax

Practice location:
  • Phone: 901-417-6551
  • Fax:
Mailing address:
  • Phone: 662-808-1053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24555
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: