1316053986 NPI number — MS. KATHERINE TOUPS GUILLORY PA-C

Table of content: MS. KATHERINE TOUPS GUILLORY PA-C (NPI 1316053986)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316053986 NPI number — MS. KATHERINE TOUPS GUILLORY PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUILLORY
Provider First Name:
KATHERINE
Provider Middle Name:
TOUPS
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TOUPS
Provider Other First Name:
PAULA
Provider Other Middle Name:
KATHERINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316053986
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8080 BLUEBONNET BLVD
Provider Second Line Business Mailing Address:
SUITE 1000
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70810-7827
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-924-2424
Provider Business Mailing Address Fax Number:
225-408-7984

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9001 SUMMA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70809-3726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-761-5200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  TA5002 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 06635831 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1109916 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".