Provider Demographics
NPI:1891089561
Name:BANKS, ADRIAN CLINT (DO)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:CLINT
Last Name:BANKS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:CAMPTON
Mailing Address - State:KY
Mailing Address - Zip Code:41301-0220
Mailing Address - Country:US
Mailing Address - Phone:606-668-6932
Mailing Address - Fax:606-668-3125
Practice Address - Street 1:239 MOUNTAIN PARKWAY SPUR RD
Practice Address - Street 2:
Practice Address - City:CAMPTON
Practice Address - State:KY
Practice Address - Zip Code:41301-8988
Practice Address - Country:US
Practice Address - Phone:606-668-3120
Practice Address - Fax:606-668-3125
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03584207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine