| Provider / Organization | NPI | Date Certified |
|---|---|---|
| JA ANNA D GUILLORY | 1063968089 | 2016-08-30 |
Ja Anna D Guillory is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1063968089. Registration indicates Ja Anna D Guillory is a provider of access to adult/geriatric primary care providers services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Physician Assistants & Advanced Practice Nursing Providers, Nurse Practitioner) (Nurse Practitioner: Family, ) (All Other Specialties & Provider Types, ) (Nurse Practitioner Family, Physician Assistants & Advanced Practice Nursing Providers) (Nurse Practitioner, )
| Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
| Entity Type | Individual |
| Provider Name | Ja Anna D Guillory FNP |
| Practice Office Address | 444 W FORT ST FL 2 BOISE, ID US |
| Practice Office Telephone | 2084221018 |
| Mailing Address | 3183 W MELBOURNE ST SPRINGFIELD, MO 658102263 US |
| Business Telephone | 4175924538 |
| Address | City / State | Phone / Fax |
|---|---|---|
| 1850 W Republic Rd | Springfield, MO 658075730 | 4178914800 |
| Code | Practice | License No State |
|---|---|---|
| 363LF0000X PRIMARY | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse PractitionerAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Nurse Practitioner: Family All Other Specialties & Provider Types Nurse Practitioner Family Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner | 2016032668
MO |