Healthcare Provider Details

I. General information

NPI: 1700319969
Provider Name (Legal Business Name): MEAGAN NICOLE SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEAGAN NICOLE ISHEE M.D

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 N ACADIA RD SUITE 100
THIBODAUX LA
70301
US

IV. Provider business mailing address

604 N ACADIA RD SUITE 100
THIBODAUX LA
70301
US

V. Phone/Fax

Practice location:
  • Phone: 985-447-9045
  • Fax:
Mailing address:
  • Phone: 601-335-2441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number346814
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number346814
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number346814
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: