Provider Demographics
NPI:1053675892
Name:BANKS, ANGELA LEAH
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LEAH
Last Name:BANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:LEAH
Other - Last Name:PIPKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:113 NEW ST
Mailing Address - Street 2:
Mailing Address - City:HORSE CAVE
Mailing Address - State:KY
Mailing Address - Zip Code:42749-1810
Mailing Address - Country:US
Mailing Address - Phone:270-528-6307
Mailing Address - Fax:
Practice Address - Street 1:113 NEW ST
Practice Address - Street 2:
Practice Address - City:HORSE CAVE
Practice Address - State:KY
Practice Address - Zip Code:42749-1810
Practice Address - Country:US
Practice Address - Phone:270-528-6307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist