Provider Demographics
NPI:1346593035
Name:BANKS, KATHY JOANN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:JOANN
Last Name:BANKS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:KATHY
Other - Middle Name:POWELL
Other - Last Name:BANKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:779 W POWELL RD
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-1346
Mailing Address - Country:US
Mailing Address - Phone:901-550-8167
Mailing Address - Fax:
Practice Address - Street 1:853 W POPLAR AVE
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-2545
Practice Address - Country:US
Practice Address - Phone:901-850-8351
Practice Address - Fax:901-266-4061
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-054361363LF0000X
TN78418363LF0000X
TN17085363L00000X
MS810540363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily