Basic Information
| Provider Information | |||||||||
| NPI: | 1568777936 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUILLORY | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | BURNS | ||||||||
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| Credential: | MN, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8490 PICARDY AVE | ||||||||
| Address2: | BLDG 200 | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708093731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252371754 | ||||||||
| FaxNumber: | 2252371722 | ||||||||
| Practice Location | |||||||||
| Address1: | 8595 PICARDY AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708093670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257634900 | ||||||||
| FaxNumber: | 2257634938 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2010 | ||||||||
| LastUpdateDate: | 06/23/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN102374-AP06197 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 3C059B116 | 01 | LA | MEDICARE PTAN | OTHER | 2127985 | 05 | LA | MEDICAID |