Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | APN8284 | TN |
NPI | 1003963166 |
---|---|
Provider Name | Kathryn V Banks |
First Address | Jackson, TN 38305-5003 |
Second Address | Brownsville, TN 38012-1607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 08/07/2007 |