Provider Demographics
NPI:1801382577
Name:GUILLORY, KRISTEN DUPLECHIN
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:DUPLECHIN
Last Name:GUILLORY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 PETROLEUM PKWY
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-8020
Mailing Address - Country:US
Mailing Address - Phone:337-465-4601
Mailing Address - Fax:
Practice Address - Street 1:1970 WEST LAUREL
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535
Practice Address - Country:US
Practice Address - Phone:337-603-4006
Practice Address - Fax:337-603-4007
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP10009363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily