Healthcare Provider Details

I. General information

NPI: 1902251184
Provider Name (Legal Business Name): JAMIE GUILLOT APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 CHARLES ST
NEW IBERIA LA
70560-3876
US

IV. Provider business mailing address

426 CHARLES ST
NEW IBERIA LA
70560-3876
US

V. Phone/Fax

Practice location:
  • Phone: 337-365-4156
  • Fax: 337-365-4192
Mailing address:
  • Phone: 337-365-4156
  • Fax: 337-365-4192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP08803
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN136435
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: