# MRS. LACY FONTENOT GUEDON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1922484757
- **Gender:** F
- **Credential:** PMHNP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | AP08776 | LA | Yes |
| 364SP0810X | Child & Family Psychiatric/Mental Health Clinical Nurse Specialist | 08776 | LA | — |

## Other

- **Enumeration date:** 08/04/2015
- **Last updated:** 04/07/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 13848326 | CAQH | — |
| 05 | — | 2421751 | — | LA |
| 01 | — | 5YJC5 | MEDICARE | LA |
| 01 | — | P02474675 | RR MEDICARE | LA |