Individual
JED MICHAEL GUILLORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
1701 OAK PARK BLVD, LAKE CHARLES, LA 70601-8911
(337) 494-3000
Mailing address
4788 W NICK CLAIRE LN, IOWA, LA 70647-5148
(337) 488-6843
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
207008
LA
Other
Enumeration date
07/29/2019
Last updated
07/29/2019
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