Provider Demographics
NPI:1154605160
Name:BANKS, SHANA RAE (APRN)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:RAE
Last Name:BANKS
Suffix:
Gender:F
Credentials:APRN
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 40
Mailing Address - Street 2:
Mailing Address - City:WHITESBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41858-0040
Mailing Address - Country:US
Mailing Address - Phone:606-633-4823
Mailing Address - Fax:606-633-1874
Practice Address - Street 1:105 ISOM PLZ
Practice Address - Street 2:
Practice Address - City:JEREMIAH
Practice Address - State:KY
Practice Address - Zip Code:41826-9088
Practice Address - Country:US
Practice Address - Phone:606-633-2233
Practice Address - Fax:606-633-2223
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007191363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily