Provider Demographics
NPI:1508466939
Name:BANKS STARKS, LAURA PATRICE (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:PATRICE
Last Name:BANKS STARKS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1438 SOM CENTER RD
Mailing Address - Street 2:NO 201
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124
Mailing Address - Country:US
Mailing Address - Phone:216-688-5110
Mailing Address - Fax:
Practice Address - Street 1:1438 SOM CENTER RD
Practice Address - Street 2:201
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44124
Practice Address - Country:US
Practice Address - Phone:216-688-5110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95175418163W00000X
TX1126119363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse