Provider Demographics
NPI:1487863155
Name:BANKS, KAMAKKI JANNI RENEE (MD)
Entity Type:Individual
Prefix:
First Name:KAMAKKI
Middle Name:JANNI RENEE
Last Name:BANKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAMAKKI
Other - Middle Name:JANNI RENEE
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1105 CENTRAL EXPY N STE 120
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6106
Mailing Address - Country:US
Mailing Address - Phone:972-747-4345
Mailing Address - Fax:469-854-8565
Practice Address - Street 1:1105 CENTRAL EXPY N STE 120
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6106
Practice Address - Country:US
Practice Address - Phone:972-747-4345
Practice Address - Fax:469-854-8565
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6159207R00000X, 207RC0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP1-0022646OtherINSTITUTIONAL PERMIT