MEDICARE: JAMIE GUILLOT APRN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN136435	LA
2	363LF0000X	Family Nurse Practitioner	AP08803	LA

General Provider Information

NPI Number	:	1902251184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE GUILLOT APRN, FNP-C

Provider Business Mailing Address
First Line	:	426 CHARLES ST
Second Line	:
City	:	NEW IBERIA
State	:	LA
Zip	:	70560-3876
Country	:	US
Telephone Number	:	337-365-4156
Fax Number	:	337-365-4192

Provider Business Practice Location Address
First Line	:	426 CHARLES ST
Second Line	:
City	:	NEW IBERIA
State	:	LA
Zip	:	70560-3876
Country	:	US
Telephone Number	:	337-365-4156
Fax Number	:	337-365-4192

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2016
Last Update Date	:	06/07/2016

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