Individual
MRS. KELLY BANKSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
11990 JACKSON ST, CLINTON, LA 70722-3210
(225) 683-5292
Mailing address
11990 JACKSON ST, CLINTON, LA 70722-3210
(225) 683-5292
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
221765
LA
Other
Enumeration date
08/18/2021
Last updated
03/09/2022
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