Provider Demographics
NPI:1831530229
Name:GUIDRY, KIM ALISON (FNP-C)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:ALISON
Last Name:GUIDRY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6057 WARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-3407
Mailing Address - Country:US
Mailing Address - Phone:504-286-5958
Mailing Address - Fax:
Practice Address - Street 1:1514 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-2429
Practice Address - Country:US
Practice Address - Phone:504-842-4015
Practice Address - Fax:504-703-0456
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905701363LF0000X
LAAP07436363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2342916Medicaid
MS07907522Medicaid
MS07907522Medicaid