Provider Demographics
NPI:1558540229
Name:BANKS, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12041 HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70818-5731
Mailing Address - Country:US
Mailing Address - Phone:225-925-8222
Mailing Address - Fax:225-925-8001
Practice Address - Street 1:921 N LOBDELL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-8811
Practice Address - Country:US
Practice Address - Phone:225-925-8222
Practice Address - Fax:225-925-8001
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARC9422171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator