Provider Demographics
NPI:1932163730
Name:DANKS, CORRIE CHRISTIANNA (MD)
Entity Type:Individual
Prefix:MRS
First Name:CORRIE
Middle Name:CHRISTIANNA
Last Name:DANKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:CORRIE
Other - Middle Name:CHRISTIANNA
Other - Last Name:NEVIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:800 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501
Mailing Address - Country:US
Mailing Address - Phone:660-665-4432
Mailing Address - Fax:660-956-4392
Practice Address - Street 1:800 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501
Practice Address - Country:US
Practice Address - Phone:660-665-4432
Practice Address - Fax:660-956-4392
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018041539208000000X, 207R00000X
KS04-28366207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H59572Medicare UPIN