Provider Demographics
NPI:1689189698
Name:LEE-BANKS, KIMARY (AGPCNP - BC)
Entity Type:Individual
Prefix:MRS
First Name:KIMARY
Middle Name:
Last Name:LEE-BANKS
Suffix:
Gender:F
Credentials:AGPCNP - BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 E EH CRUMP BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38126-5394
Mailing Address - Country:US
Mailing Address - Phone:901-261-2000
Mailing Address - Fax:
Practice Address - Street 1:360 E EH CRUMP BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38126-5394
Practice Address - Country:US
Practice Address - Phone:901-261-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-13
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903682363LG0600X
TN23681363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology