Provider Demographics
NPI:1013344274
Name:GUILLORY, SHAWANNA MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:SHAWANNA
Middle Name:MARIE
Last Name:GUILLORY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2651
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70571-2651
Mailing Address - Country:US
Mailing Address - Phone:337-384-9219
Mailing Address - Fax:
Practice Address - Street 1:811 ALBERTSON PKWY STE G
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518-5256
Practice Address - Country:US
Practice Address - Phone:337-290-8520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07537363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily