Provider Demographics
NPI:1629627773
Name:BANKS, LATONYA RENEE (APRN)
Entity Type:Individual
Prefix:
First Name:LATONYA
Middle Name:RENEE
Last Name:BANKS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12024 LAVENIA LN STE 105
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40272-6100
Mailing Address - Country:US
Mailing Address - Phone:502-302-9241
Mailing Address - Fax:502-456-0496
Practice Address - Street 1:2902 BARDSTOWN RD STE D
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3066
Practice Address - Country:US
Practice Address - Phone:502-808-1048
Practice Address - Fax:949-561-4663
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013776363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner