Provider Demographics
NPI:1386130466
Name:WILBANKS, CHRISTOPHER CORY (DNP, APRN, FNP, CNL)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:CORY
Last Name:WILBANKS
Suffix:
Gender:M
Credentials:DNP, APRN, FNP, CNL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3445 POPLAR AVE STE 18
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-4667
Mailing Address - Country:US
Mailing Address - Phone:662-808-1053
Mailing Address - Fax:
Practice Address - Street 1:3445 POPLAR AVE STE 18
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111
Practice Address - Country:US
Practice Address - Phone:901-417-6551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24555363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily