Individual
EBONY BANKSTON-KING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
166 BARRY AVE, MASCOTTE, FL 34753-9707
(501) 710-1545
Mailing address
166 BARRY AVE, MASCOTTE, FL 34753-9707
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
CNA442324
FL
Other
Enumeration date
10/25/2023
Last updated
10/25/2023
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