Healthcare Provider Details

I. General information

NPI: 1851336697
Provider Name (Legal Business Name): JULIE M THIBODAUX APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 GENE GEORGE BLVD
SPRINGDALE AR
72762-6385
US

IV. Provider business mailing address

1 CHILDRENS WAY # 653
LITTLE ROCK AR
72202-3500
US

V. Phone/Fax

Practice location:
  • Phone: 479-780-0125
  • Fax: 479-750-0323
Mailing address:
  • Phone: 501-364-1100
  • Fax: 501-364-4082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberA001726
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberA001726
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: