Provider Demographics
NPI:1184031726
Name:JOSEPH M. BANKS
Entity Type:Organization
Organization Name:JOSEPH M. BANKS
Other - Org Name:JOE BANKS APRN FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:606-634-8196
Mailing Address - Street 1:104 MCCRAY LN
Mailing Address - Street 2:
Mailing Address - City:MILLSTONE
Mailing Address - State:KY
Mailing Address - Zip Code:41838-8922
Mailing Address - Country:US
Mailing Address - Phone:606-634-8196
Mailing Address - Fax:
Practice Address - Street 1:756 HIGHWAY 2034
Practice Address - Street 2:
Practice Address - City:WHITESBURG
Practice Address - State:KY
Practice Address - Zip Code:41858-7500
Practice Address - Country:US
Practice Address - Phone:606-634-8196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-15
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3206363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100305760Medicaid
KYK160030Medicare PIN