Provider Demographics
NPI:1992122097
Name:BANFORD, ALISON
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:BANFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 TUCKER STATION RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-4525
Mailing Address - Country:US
Mailing Address - Phone:502-366-0705
Mailing Address - Fax:
Practice Address - Street 1:2210 TUCKER STATION RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-4525
Practice Address - Country:US
Practice Address - Phone:502-366-0705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker