Individual
KEVIN BANKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1111 MEDICAL CENTER BLVD STE S850, MARRERO, LA 70072-3173
(504) 349-6450
(504) 349-6454
Mailing address
125 W 40TH PL, CUT OFF, LA 70345-3078
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
207227
LA
Other
Enumeration date
09/07/2023
Last updated
09/22/2023
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