Healthcare Provider Details

I. General information

NPI: 1831182963
Provider Name (Legal Business Name): CHRISTOPHER BANNER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 NORTH GRAND AVE
FORT THOMAS KY
41075
US

IV. Provider business mailing address

401 E 20TH ST SUITE 5A
COVINGTON KY
41014-1583
US

V. Phone/Fax

Practice location:
  • Phone: 859-572-3232
  • Fax: 859-572-3727
Mailing address:
  • Phone: 859-655-7160
  • Fax: 859-655-6742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1114679
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number278038
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number5333A
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: