MEDICARE: JOSEPH MICHAEL 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	5686P	KY
2	363LF0000X	Family Nurse Practitioner	3005686	KY

General Provider Information

NPI Number	:	1275778987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH MICHAEL BANKS APRN

Provider Business Mailing Address
First Line	:	104 MCCRAY LN
Second Line	:
City	:	MILLSTONE
State	:	KY
Zip	:	41838-8922
Country	:	US
Telephone Number	:	606-634-8196
Fax Number	:

Provider Business Practice Location Address
First Line	:	756 HIGHWAY 2034
Second Line	:
City	:	WHITESBURG
State	:	KY
Zip	:	41858-7500
Country	:	US
Telephone Number	:	606-634-8153
Fax Number	:

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

Provider Enumeration Date	:	12/09/2008
Last Update Date	:	07/08/2014

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