MEDICARE: MR. JOHN BANKS TILMON PA-C

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	363A00000X	Physician Assistant	A10255RX	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	:	1619903721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN BANKS TILMON PA-C

Provider Business Mailing Address
First Line	:	1315 STUBBS VINSON RD
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71203-8553
Country	:	US
Telephone Number	:	318-343-2483
Fax Number	:

Provider Business Practice Location Address
First Line	:	10374 HIGHWAY 165 N STE B
Second Line	:
City	:	STERLINGTON
State	:	LA
Zip	:	71280-3320
Country	:	US
Telephone Number	:	318-665-4543
Fax Number	:

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	08/18/2025

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