Provider Demographics
NPI:1508831561
Name:BANKS, DIANA MARIE (ARNP, CDE)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:MARIE
Last Name:BANKS
Suffix:
Gender:F
Credentials:ARNP, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HILLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1538
Mailing Address - Country:US
Mailing Address - Phone:502-895-8697
Mailing Address - Fax:
Practice Address - Street 1:3101 BRECKENRIDGE LN
Practice Address - Street 2:4E
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-2742
Practice Address - Country:US
Practice Address - Phone:502-454-5252
Practice Address - Fax:502-454-5353
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2051P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000337316OtherANTHEM
S50964Medicare UPIN
KY000000337316OtherANTHEM
KYP00230058Medicare PIN