Individual
KIMBERLY J. BANKSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
385 S ORANGE ST, EL PASO, IL 61738-1613
(309) 527-4900
(309) 527-3525
Mailing address
PO BOX 2451, BLOOMINGTON, IL 61702-2451
(309) 268-2172
(309) 268-3949
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
20900121
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10220308
BLUE CROSS BLUE SHIELD
—
01
—
5720935
BLUE CROSS BLUE SHIELD
—
Enumeration date
07/14/2006
Last updated
07/08/2007
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