Provider Demographics
NPI:1043020936
Name:BANKSTON, OLIVA (FNP-C)
Entity type:Individual
Prefix:
First Name:OLIVA
Middle Name:
Last Name:BANKSTON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14152 HORSESHOE BND
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3520
Mailing Address - Country:US
Mailing Address - Phone:936-777-5994
Mailing Address - Fax:
Practice Address - Street 1:24375 FM 1314 RD
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-4205
Practice Address - Country:US
Practice Address - Phone:281-354-5663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1186741363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily