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NPI Code Detail

MEDICARE: KIMBERLY J. BANKSTON ANP

MEDICARE: KIMBERLY J. BANKSTON ANP
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
1363LF0000XFamily Nurse Practitioner20900121IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15720935OTHERBLUE CROSS BLUE SHIELD
210220308OTHERBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1962428003
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY J. BANKSTON ANP
Provider Business Mailing Address
First Line : PO BOX 2451
Second Line :
City : BLOOMINGTON
State : IL
Zip : 61702-2451
Country : US
Telephone Number : 309-268-2172
Fax Number : 309-268-3949
Provider Business Practice Location Address
First Line : 385 S ORANGE ST
Second Line :
City : EL PASO
State : IL
Zip : 61738-1613
Country : US
Telephone Number : 309-527-4900
Fax Number : 309-527-3525
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2006
Last Update Date : 07/08/2007

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Directions to “ KIMBERLY J. BANKSTON ANP” Practice Location

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