MEDICARE: KATLYN CROFT THIBODEAUX

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	S9282	TX

General Provider Information

NPI Number	:	1871054544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATLYN CROFT THIBODEAUX

Provider Business Mailing Address
First Line	:	601 OGLETREE DR STE A
Second Line	:
City	:	LIVINGSTON
State	:	TX
Zip	:	77351-9227
Country	:	US
Telephone Number	:	936-327-5686
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 OGLETREE DR STE A
Second Line	:
City	:	LIVINGSTON
State	:	TX
Zip	:	77351-9227
Country	:	US
Telephone Number	:	936-327-5686
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2019
Last Update Date	:	03/05/2026

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