# MED ONE HEALTH CLINIC, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609681345
- **Authorized official:** DR. LATRISALA BANKSTON NP (OWNER)
- **Authorized official phone:** (832) 870-8375

## Contact information

- **Practice address:** 349 DOGWOOD SOUTH LN, HAUGHTON, LA 71037-8511
- **Practice address phone:** (832) 870-8375
- **Mailing address:** 349 DOGWOOD SOUTH LN, HAUGHTON, LA 71037-8511

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 02/10/2025
- **Last updated:** 02/12/2025