Provider Demographics
NPI:1851859177
Name:GUILLORY, DANA LYNN
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:LYNN
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 1:114 PARKWAY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-8152
Mailing Address - Country:US
Mailing Address - Phone:096-580-6254
Mailing Address - Fax:
Practice Address - Street 1:904 FM 686
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TX
Practice Address - Zip Code:77535-2299
Practice Address - Country:US
Practice Address - Phone:936-258-2476
Practice Address - Fax:936-257-4447
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139701363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily