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General NPI Number Information
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NPI Number | 1962065219
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Entity Type | Individual
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Provider Name | KAITLYN R BANNING
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Gender | Female
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Dates
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Enumeration Date | 04/22/2019
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 1005 DIVISION ST
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City | PRESCOTT
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State | AZ
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Zip | 86301-1601
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Country | US
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Telephone | 928-776-8428
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Fax |
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Provider Business Mailing Address
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Address Line | 1005 DIVISION ST
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City | PRESCOTT
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State | AZ
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Zip | 86301-1601
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Country | US
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Telephone | 928-776-8428
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Fax | 833-449-5321
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 5101027374
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 011238
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License Number State | AZ
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