Healthcare Provider Details

I. General information

NPI: 1790273670
Provider Name (Legal Business Name): KATRINA BROWN BANKINS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 OLD AIRPORT RD
CONCORD NC
28025-7188
US

IV. Provider business mailing address

9543 INDIAN BEECH AVE NW
CONCORD NC
28027-3573
US

V. Phone/Fax

Practice location:
  • Phone: 704-260-5600
  • Fax:
Mailing address:
  • Phone: 757-254-8220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14079
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: