Healthcare Provider Details

I. General information

NPI: 1588278246
Provider Name (Legal Business Name): CAROLINE ELIZABETH AYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 10/22/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 RIDGEFIELD RD
THIBODAUX LA
70301-4333
US

IV. Provider business mailing address

317 HALE DR
THIBODAUX LA
70301-5603
US

V. Phone/Fax

Practice location:
  • Phone: 985-446-7341
  • Fax:
Mailing address:
  • Phone: 985-413-2701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number324550
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: