Healthcare Provider Details

I. General information

NPI: 1144690173
Provider Name (Legal Business Name): KIERRA BANKS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIERRA BANKS MILES LMSW

II. Dates (important events)

Enumeration Date: 10/02/2015
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 W MORRIS AVE STE E
HAMMOND LA
70403-3854
US

IV. Provider business mailing address

1417 W MORRIS AVE STE E
HAMMOND LA
70403-3854
US

V. Phone/Fax

Practice location:
  • Phone: 985-662-3799
  • Fax:
Mailing address:
  • Phone: 985-662-3799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number16370
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: