Provider Demographics
NPI:1669416608
Name:BANKS, JOANNA (CNM, APRN)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:CNM, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1348
Mailing Address - Country:US
Mailing Address - Phone:859-404-7686
Mailing Address - Fax:859-274-4312
Practice Address - Street 1:225 HOSPITAL DRIVE
Practice Address - Street 2:BUILDING B, SUITE 255
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391
Practice Address - Country:US
Practice Address - Phone:859-744-2623
Practice Address - Fax:859-744-9421
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002533367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78253309Medicaid
KY000000076743OtherBCBS
KY0641902Medicare PIN
KY000000076743OtherBCBS
KY78253309Medicaid
KY500012998Medicare PIN
KYS50953Medicare UPIN