Provider Demographics
NPI:1427746775
Name:BANTON, KERRONIE
Entity type:Individual
Prefix:
First Name:KERRONIE
Middle Name:
Last Name:BANTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9707 SENTINEL PEAK PL
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-8772
Mailing Address - Country:US
Mailing Address - Phone:760-712-1533
Mailing Address - Fax:
Practice Address - Street 1:5080 CALIFORNIA AVE STE 250
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0732
Practice Address - Country:US
Practice Address - Phone:661-258-3240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician