Healthcare Provider Details

I. General information

NPI: 1467335596
Provider Name (Legal Business Name): CHRISTINE GUIDRY PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 OLD CANTON RD
JACKSON MS
39211-5982
US

IV. Provider business mailing address

4400 OLD CANTON RD
JACKSON MS
39211-5982
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-5236
  • Fax: 601-984-5236
Mailing address:
  • Phone: 601-984-5236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number917657
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number907561
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: