Provider Demographics
NPI:1336506922
Name:LEE GUIDRY, CODIE JESSICA (NP)
Entity Type:Individual
Prefix:
First Name:CODIE
Middle Name:JESSICA
Last Name:LEE GUIDRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 N HIGHWAY 171 STE 10
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70611-5374
Mailing Address - Country:US
Mailing Address - Phone:337-217-7762
Mailing Address - Fax:
Practice Address - Street 1:277 N HIGHWAY 171 STE 10
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70611-5374
Practice Address - Country:US
Practice Address - Phone:337-217-7762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN128288163W00000X
LAAP08635363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2409891Medicaid
LA476519YH5NMedicare PIN