Healthcare Provider Details

I. General information

NPI: 1558297481
Provider Name (Legal Business Name): MRS. KOURTNEY THIBODEAUX BREAUX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 WRIGHT AVE STE D
CROWLEY LA
70526-2226
US

IV. Provider business mailing address

475 SENSAT COVE RD
EGAN LA
70531-3803
US

V. Phone/Fax

Practice location:
  • Phone: 337-514-5181
  • Fax: 337-514-5182
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: