MEDICARE: KIERRA BANKS LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	104100000X	Social Worker	16370	LA

General Provider Information

NPI Number	:	1144690173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIERRA BANKS LMSW

Provider Business Mailing Address
First Line	:	1417 W MORRIS AVE STE E
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70403-3854
Country	:	US
Telephone Number	:	985-662-3799
Fax Number	:

Provider Business Practice Location Address
First Line	:	1417 W MORRIS AVE STE E
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70403-3854
Country	:	US
Telephone Number	:	985-662-3799
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2015
Last Update Date	:	12/05/2024

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