Provider Demographics
NPI:1205348919
Name:GUILLOT, STEPHEN W (NP)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:W
Last Name:GUILLOT
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16851 RIO RED
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-2625
Mailing Address - Country:US
Mailing Address - Phone:956-505-1035
Mailing Address - Fax:
Practice Address - Street 1:1019 S UTAH AVE STE C
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-5588
Practice Address - Country:US
Practice Address - Phone:956-376-2325
Practice Address - Fax:956-376-2326
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-03
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX742522363L00000X, 363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner