Provider Demographics
NPI:1841428695
Name:GUIDRY, CASSIE RODRIGUEZ (PA-C)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:RODRIGUEZ
Last Name:GUIDRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4864 REBELLE LN
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEN
Mailing Address - State:LA
Mailing Address - Zip Code:70767-4218
Mailing Address - Country:US
Mailing Address - Phone:985-438-0697
Mailing Address - Fax:
Practice Address - Street 1:4864 REBELLE LN
Practice Address - Street 2:
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767-4218
Practice Address - Country:US
Practice Address - Phone:985-438-0697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200283363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1893811Medicaid
LA1893811Medicaid