Provider Demographics
NPI:1174115059
Name:PERKS BANKS, JANEE NICOLE
Entity type:Individual
Prefix:MRS
First Name:JANEE
Middle Name:NICOLE
Last Name:PERKS BANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2928 DUMESNIL STREET
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40211
Mailing Address - Country:US
Mailing Address - Phone:502-210-2310
Mailing Address - Fax:
Practice Address - Street 1:2724 ROCKFORD LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-2216
Practice Address - Country:US
Practice Address - Phone:502-210-2310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2028671744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty