Provider Demographics
NPI:1568715662
Name:ROUGELOT, AMY GUIDRY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:GUIDRY
Last Name:ROUGELOT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:THERESE
Other - Last Name:GUIDRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 8770
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70011-8770
Mailing Address - Country:US
Mailing Address - Phone:504-529-6600
Mailing Address - Fax:504-529-6769
Practice Address - Street 1:1717 ST CHARLES AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130
Practice Address - Country:US
Practice Address - Phone:504-529-6600
Practice Address - Fax:504-529-6769
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200561363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant