Healthcare Provider Details

I. General information

NPI: 1679028260
Provider Name (Legal Business Name): RACHELLE R GUIDRY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2016
Last Update Date: 03/24/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 HIGHWAY 3162
CUT OFF LA
70345-3582
US

IV. Provider business mailing address

314 HIGHWAY 3162
CUT OFF LA
70345-3582
US

V. Phone/Fax

Practice location:
  • Phone: 985-632-1820
  • Fax: 985-632-1824
Mailing address:
  • Phone: 985-632-1820
  • Fax: 985-632-1824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP08806
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP08806
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: