MEDICARE: JENNIFER W BANKS N.P.

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	363L00000X	Nurse Practitioner	APO3690	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588795405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER W BANKS N.P.

Provider Business Mailing Address
First Line	:	411 E VAUGHN AVE
Second Line	:	SUITE 202
City	:	RUSTON
State	:	LA
Zip	:	71270-5972
Country	:	US
Telephone Number	:	318-521-3774
Fax Number	:	318-251-0442

Provider Business Practice Location Address
First Line	:	411 E VAUGHN AVE
Second Line	:	SUITE 202
City	:	RUSTON
State	:	LA
Zip	:	71270-5972
Country	:	US
Telephone Number	:	318-251-3774
Fax Number	:	318-251-0442

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

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	11/30/2016

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