Provider Demographics
NPI:1710395660
Name:GUILLORY, JENNIFER DORAND (APRN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DORAND
Last Name:GUILLORY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4405 HIGHWAY 190 EAST SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-4957
Mailing Address - Country:US
Mailing Address - Phone:985-893-8505
Mailing Address - Fax:985-893-0093
Practice Address - Street 1:4405 HIGHWAY 190 EAST SERVICE RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-4957
Practice Address - Country:US
Practice Address - Phone:985-893-8505
Practice Address - Fax:985-893-0093
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07957363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics