Provider Demographics
NPI:1497340343
Name:GUIDRY, AMY (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:GUIDRY
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5902
Mailing Address - Country:US
Mailing Address - Phone:337-302-7955
Mailing Address - Fax:
Practice Address - Street 1:621 E MILLER AVE
Practice Address - Street 2:
Practice Address - City:IOWA
Practice Address - State:LA
Practice Address - Zip Code:70647-4008
Practice Address - Country:US
Practice Address - Phone:337-358-2701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA215693363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily