Provider Demographics
NPI:1649515578
Name:BANKS, KAI (PNP)
Entity type:Individual
Prefix:
First Name:KAI
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:KAI
Other - Middle Name:
Other - Last Name:SYKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19091 WILTSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2513
Mailing Address - Country:US
Mailing Address - Phone:404-449-9499
Mailing Address - Fax:248-809-9074
Practice Address - Street 1:17330 NORTHLAND PARK CT STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4319
Practice Address - Country:US
Practice Address - Phone:248-392-2286
Practice Address - Fax:248-809-9074
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704239724363LP0200X
GARN226809363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics