Healthcare Provider Details

I. General information

NPI: 1588906317
Provider Name (Legal Business Name): MEGAN CLARY GUILLORY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 E SAINT PETER ST.
NEW IBERIA LA
70560
US

IV. Provider business mailing address

1110 E SAINT PETER ST.
NEW IBERIA LA
70560
US

V. Phone/Fax

Practice location:
  • Phone: 337-364-1166
  • Fax:
Mailing address:
  • Phone: 337-364-1166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA200596
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: