Provider Demographics
NPI:1730248535
Name:BANISTER, KAREN CUMMINGS (MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:CUMMINGS
Last Name:BANISTER
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Gender:F
Credentials:MD
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Mailing Address - Street 1:2850 LONE OAK RD
Mailing Address - Street 2:BAYLEY SQUARE, SUITE 4
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-8043
Mailing Address - Country:US
Mailing Address - Phone:270-554-3904
Mailing Address - Fax:270-534-8928
Practice Address - Street 1:2850 LONE OAK RD
Practice Address - Street 2:BAYLEY SQUARE, SUITE 4
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-8043
Practice Address - Country:US
Practice Address - Phone:270-554-3904
Practice Address - Fax:270-534-8928
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2010-07-09
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Provider Licenses
StateLicense IDTaxonomies
KY32562207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64325624Medicaid
KY0634803Medicare ID - Type Unspecified
KY64325624Medicaid