NPIMap

Individual provider Active NPI

Kelly Bankston, APRN

  • Family Nurse Practitioner
  • Clinton, LA
National Provider Identifier
1073289104
Registry record updated Mar 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
221765 Issued in LA
Practice address
11990 Jackson St
Clinton, LA 70722-3210
Phone
(225) 683-5292
NPI assigned
Aug 18, 2021
Last updated
Mar 9, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 221765 LA Primary

Addresses

Primary practice location

11990 Jackson St
Clinton, LA 70722-3210

Mailing address

11990 Jackson St
Clinton, LA 70722-3210
Phone (225) 683-5292

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211229000201 LA Practitioner - Nurse Practitioner 4284025305 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

11990 Jackson St
Clinton, LA 70722-3210
Phone (225) 683-5292

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
221765LAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Primary Care Providers for a Healthy Feliciana, Inc CurrentSince Nov 29, 2021 Accepting new patients
Primary Care Providers for a Healthy Feliciana, Inc. Current Accepting new patients
Primary Care Providers for a Healthy Feliciana Inc CurrentSince Nov 29, 2021 Accepting new patients
Primary Care Providers for a Healthy Feliciana, Inc. Past Accepting new patients
Primary Care Providers for a Healthy Feliciana Inc Past Accepting new patients
Primary Care Providers for a Healthy Feliciana, Inc Past Accepting new patients
Primary Care Providers for a Healthy Feliciana, Inc Past Accepting new patients
Primary Care Providers for a Healthy Feliciana, Inc Past Accepting new patients

Locations

455 E Airport Ave
Baton Rouge, LA 70806
Phone (225) 201-0950

10410 Plank Rd
Clinton, LA 70722
Phone (225) 683-8877

11990 Jackson St
Clinton, LA 70722
Phone (225) 570-6111

3501 Highway 10
Jackson, LA 70748
Phone (225) 683-1360

28315 S Frost Rd
Livingston, LA 70754
Phone (225) 283-1356

54016 Highway 1062
Loranger, LA 70446
Phone (985) 606-9000

3553 Rosedale Rd
Port Allen, LA 70767
Phone (225) 234-0227

Interoperability endpoints

  • Direct secure messaging: kelly.bankston.p1@direct.rkmprimarycare.nextgenshare.com

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646784000000",
    "number": "1073289104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11990 JACKSON ST",
            "city": "CLINTON",
            "state": "LA",
            "postal_code": "707223210",
            "telephone_number": "225-683-5292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11990 JACKSON ST",
            "city": "CLINTON",
            "state": "LA",
            "postal_code": "707223210",
            "telephone_number": "225-683-5292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANKSTON",
        "first_name": "KELLY",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-18",
        "last_updated": "2022-03-09",
        "certification_date": "2022-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "221765",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton, LA

Sources for this page

Verify at the official NPI Registry.