Provider Demographics
NPI:1295599728
Name:BANKS, TAYLOR LEONA (PA-C)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LEONA
Last Name:BANKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 FOX MEADOWS BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-6939
Mailing Address - Country:US
Mailing Address - Phone:865-366-1581
Mailing Address - Fax:
Practice Address - Street 1:1108 FOX MEADOWS BLVD STE 1
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-6939
Practice Address - Country:US
Practice Address - Phone:865-366-1581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5868363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant