MEDICARE: KIM BANKS CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	SP008803	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SP008803	OTHER	PA	LICENSE

General Provider Information

NPI Number	:	1497775647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM BANKS CRNP

Provider Business Mailing Address
First Line	:	634 ALPHA DR
Second Line	:	SUITE 600
City	:	PITTSBURGH
State	:	PA
Zip	:	15238-2802
Country	:	US
Telephone Number	:	610-892-8991
Fax Number	:

Provider Business Practice Location Address
First Line	:	634 ALPHA DR
Second Line	:	SUITE 600
City	:	PITTSBURGH
State	:	PA
Zip	:	15238-2802
Country	:	US
Telephone Number	:	610-892-8991
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	05/15/2014

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