Basic Information
| Provider Information | |||||||||
| NPI: | 1669416608 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BANKS | ||||||||
| FirstName: | JOANNA | ||||||||
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| Credential: | CNM, APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 236 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT STERLING | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403531348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8594047686 | ||||||||
| FaxNumber: | 8592744312 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 HOSPITAL DRIVE | ||||||||
| Address2: | BUILDING B, SUITE 255 | ||||||||
| City: | WINCHESTER | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8597442623 | ||||||||
| FaxNumber: | 8597449421 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 05/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 3002533 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 78253309 | 05 | KY | MEDICAID |