Individual
MRS. LACY FONTENOT GUEDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
2104 LOOP RD STE C, WINNSBORO, LA 71295-3341
(318) 435-6377
(318) 435-6378
Mailing address
PO BOX 1300, WINNSBORO, LA 71295-3344
(318) 435-6377
(318) 435-6378
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP08776
LA
364SP0810X
Child & Family Psychiatric/Mental Health Clinical Nurse Specialist
08776
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13848326
CAQH
—
05
—
2421751
—
LA
01
—
5YJC5
MEDICARE
LA
01
—
P02474675
RR MEDICARE
LA
Enumeration date
08/04/2015
Last updated
04/07/2021
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