Individual
TIFFANY NICOLE BANKSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
609 S KELLY AVE, SUITE J1, EDMOND, OK 73003-5659
(405) 285-8315
(405) 285-8318
Mailing address
609 S KELLY AVE, SUITE J1, EDMOND, OK 73003-5659
(405) 285-8315
(405) 285-8318
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1478
OK
Other
Enumeration date
08/20/2008
Last updated
08/20/2008
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