Kelly Elizabeth Guedry, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6349 Issued in LA

Practice address

11990 Jackson St
Clinton, LA 70722-3210

Phone

(225) 683-5292

Fax

(225) 683-1310

NPI assigned

Jun 5, 2013

Sex

Female

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Babin Dental LLC

  • Dentist
  • Baton Rouge, LA
  • NPI 1427422930
  NPD (past)

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: kelly.guedry.p1@direct.rkmprimarycare.nextgenshare.com

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 19, 2024.

{
    "created_epoch": "1370390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710806400000",
    "number": "1457799082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3526 BON SEJOUR AVE",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708205061",
            "telephone_number": "985-513-0681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11990 JACKSON ST",
            "city": "CLINTON",
            "state": "LA",
            "postal_code": "707223210",
            "telephone_number": "225-683-5292",
            "fax_number": "225-683-1310"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10631 Hillary Ct",
            "address_purpose": "LOCATION",
            "city": "Baton Rouge",
            "state": "LA",
            "postal_code": "708102842",
            "country_code": "US",
            "telephone_number": "225-590-3835",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUEDRY",
        "first_name": "KELLY",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-05",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "6349",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "LA",
            "license": "6349",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1863491",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Iesha Marie Harris
• Frances R Havard, RN

• All providers in Clinton, LA
• General Practice Dentistry in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.