Healthcare Provider Details

I. General information

NPI: 1497775647
Provider Name (Legal Business Name): KIM BANKS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 05/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

634 ALPHA DR SUITE 600
PITTSBURGH PA
15238-2802
US

IV. Provider business mailing address

634 ALPHA DR SUITE 600
PITTSBURGH PA
15238-2802
US

V. Phone/Fax

Practice location:
  • Phone: 610-892-8991
  • Fax:
Mailing address:
  • Phone: 610-892-8991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP008803
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: