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1073289104
KELLY BANKSTON
CLINTON, LA
NPI
1073289104
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: LA 221765)
Enumeration Date
2021-08-18
Last Update Date
2022-03-09
Business Address
Mrs. KELLY BANKSTON APRN
11990 JACKSON ST
CLINTON, LA 70722-3210
Phone number: 225-683-5292
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Mailing Address
Mrs. KELLY BANKSTON APRN
11990 JACKSON ST
CLINTON, LA 70722-3210
Phone number: 225-683-5292
Copy
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