Provider Demographics
NPI:1275778987
Name:BANKS, JOSEPH MICHAEL (APRN)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:BANKS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:606-634-8153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5686P363LF0000X
KY3005686363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily