Healthcare Provider Details

I. General information

NPI: 1942717269
Provider Name (Legal Business Name): JOSHUA MARK THIGPEN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 01/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 KALISTE SALOOM RD
LAFAYETTE LA
70508-5705
US

IV. Provider business mailing address

3600 KALISTE SALOOM RD APT 515
LAFAYETTE LA
70508-7617
US

V. Phone/Fax

Practice location:
  • Phone: 337-470-1000
  • Fax:
Mailing address:
  • Phone: 409-673-6735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP09699
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: