=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376036657
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HALEY STARKEY BANKS MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2018
-----------------------------------------------------
Last Update Date | 10/05/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 RIVER NORTH BLVD
-----------------------------------------------------
City | STEPHENVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76401-1860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-968-6051
-----------------------------------------------------
Fax | 254-968-4204
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 150 RIVER NORTH BLVD
-----------------------------------------------------
City | STEPHENVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76401-1860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-968-6051
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | T2318
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | T2318
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------