Provider Demographics
NPI:1003963166
Name:BANKS, KATHRYN V (PNP-PC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:V
Last Name:BANKS
Suffix:
Gender:F
Credentials:PNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 RIDGE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-2628
Mailing Address - Country:US
Mailing Address - Phone:919-467-5543
Mailing Address - Fax:
Practice Address - Street 1:105 RIDGE VIEW DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-2628
Practice Address - Country:US
Practice Address - Phone:919-467-5543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004007363LP0200X
TNAPN8284363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MB1045093OtherDEA NUMBER