Provider Demographics
NPI:1386767770
Name:BANKS, KATHLEEN (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12880 HILLCREST RD STE 104
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-6557
Mailing Address - Country:US
Mailing Address - Phone:972-980-8055
Mailing Address - Fax:972-490-3567
Practice Address - Street 1:12880 HILLCREST RD STE 104
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6557
Practice Address - Country:US
Practice Address - Phone:972-980-8055
Practice Address - Fax:972-490-3567
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH60252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry