MEDICARE: SHANA RAE BANKS APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	3007191	KY

General Provider Information

NPI Number	:	1154605160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANA RAE BANKS APRN

Provider Business Mailing Address
First Line	:	PO BOX 40
Second Line	:
City	:	WHITESBURG
State	:	KY
Zip	:	41858-0040
Country	:	US
Telephone Number	:	606-633-4823
Fax Number	:	606-633-1874

Provider Business Practice Location Address
First Line	:	105 ISOM PLZ
Second Line	:
City	:	JEREMIAH
State	:	KY
Zip	:	41826-9088
Country	:	US
Telephone Number	:	606-633-2233
Fax Number	:	606-633-2223

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2011
Last Update Date	:	08/03/2016

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Directions to “ SHANA RAE BANKS APRN” Practice Location

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