Provider Demographics
NPI:1053617175
Name:BANKS, MEGAN LEA COLLMAN (FNP)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:LEA COLLMAN
Last Name:BANKS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:LEA
Other - Last Name:COLLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7701 N LAMAR BLVD
Mailing Address - Street 2:STE 206
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-1000
Mailing Address - Country:US
Mailing Address - Phone:512-649-2270
Mailing Address - Fax:512-727-0476
Practice Address - Street 1:7701 N LAMAR BLVD
Practice Address - Street 2:STE 206
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-1000
Practice Address - Country:US
Practice Address - Phone:512-649-2270
Practice Address - Fax:512-727-0476
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX698138363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX698138Medicare UPIN