Individual
DR. KYRA HEATHER BANNISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
(570) 887-4464
Mailing address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
162645-1
NY
207L00000X
Anesthesiology Physician
Primary
MD044464E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011740400001
—
PA
05
—
01070084
—
NY
01
—
050075742
RR MEDICARE PIN
PA
01
—
CC8362
RR MEDICARE GROUP
NY
01
—
CC9269
RR MEDICARE GROUP
—
01
—
GU039832
MEDICARE GROUP
PA
01
—
P00693905
RR MEDICARE PIN
NY
Enumeration date
02/27/2006
Last updated
03/25/2011
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