Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1154687788 |
---|---|
Provider Name | Mrs. Kelli Lynn Bankes |
First Address | Fort Worth, TX 76244-7976 |
Second Address | Fort Worth, TX 76244-7976 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2012 |
Last Update Date | 09/04/2012 |