Provider Demographics
NPI:1972859130
Name:BANKSTON, SHERYL MEI (FNP-BC)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:MEI
Last Name:BANKSTON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:1200 E MAIN ST
Practice Address - Street 2:SUITE 12
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1711
Practice Address - Country:US
Practice Address - Phone:864-560-9260
Practice Address - Fax:864-560-9265
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17931363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC10686084OtherMEDICARE PIN
SCSC10686121OtherMEDICARE PIN
SCNP2367Medicaid
SCSC10685019OtherMEDICARE PIN
SCSC1068J577OtherMEDICARE PIN
SCP01226933OtherRAILROAD MEDICARE
SCSC10686067OtherMEDICARE PIN