Healthcare Provider Details

I. General information

NPI: 1689189698
Provider Name (Legal Business Name): KIMARY LEE-BANKS AGPCNP - BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 E EH CRUMP BLVD
MEMPHIS TN
38126-5394
US

IV. Provider business mailing address

360 E EH CRUMP BLVD
MEMPHIS TN
38126-5394
US

V. Phone/Fax

Practice location:
  • Phone: 901-261-2000
  • Fax:
Mailing address:
  • Phone: 901-261-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number903682
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number23681
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: