Provider Demographics
NPI:1891256434
Name:GUILLORY, JOANN MERCEDES GEORGES (ARNP)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:MERCEDES GEORGES
Last Name:GUILLORY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 BERKSHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-2218
Mailing Address - Country:US
Mailing Address - Phone:281-736-8387
Mailing Address - Fax:
Practice Address - Street 1:56 BERKSHIRE CIR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-2218
Practice Address - Country:US
Practice Address - Phone:281-736-8387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX139801363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily