Healthcare Provider Details

I. General information

NPI: 1154689016
Provider Name (Legal Business Name): BILLY BANKS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 NAUTILUS DR
HAZARD KY
41701-8609
US

IV. Provider business mailing address

160 NAUTILUS DR
HAZARD KY
41701-8609
US

V. Phone/Fax

Practice location:
  • Phone: 606-436-2350
  • Fax:
Mailing address:
  • Phone: 606-436-2350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number03997
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: