Mallory Bankston, APRN, FNP-C
Individual provider Active NPI Family Nurse Practitioner · Baker, LA
NPI 1174938211 · NPPES record last updated Aug 12, 2022
Key facts
- NPI
- 1174938211
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- AP07816 (LA)
- Practice address
- 12880 Plank Rd
Baker, LA 70714-4909 - Phone
- (225) 774-7111
- Fax
- (225) 774-7714
- NPI assigned
- Jun 27, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160827000167 | LA | Practitioner - Nurse Practitioner | 7416242524 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP07816 | LA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Zachary Internal Medicine Clinic LLC | Current |
Accepting new patients |
Locations
1169 Highway 19
#B
Slaughter, LA 70777
Phone (225) 513-7155
19850 Old Scenic Hwy
Ste 300
Zachary, LA 70791
Phone (225) 513-7155
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | AP07816 | LA | Yes |
Addresses
Primary practice location
12880 Plank Rd
Baker, LA 70714-4909
Mailing address
12880 Plank Rd
Baker, LA 70714-4909
Phone (225) 774-7111
Other providers in Baker, LA
- Baker Eye Care
- Baker Medical Corporation, LTD
- Baker Physical Therapy Clinic
- Baker School Based Health Clinic
- Baker Wellness Center Adhc
- Jeremy Beauchamp
- Maisha Lashawn Beauchamp
- Cicella Lorine Benton
- Ashley Michelle Biagas
- Kayla Holliday Bibbins
All providers in Baker, LA · Family Nurse Practitioner in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 12, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.