Healthcare Provider Details

I. General information

NPI: 1467204651
Provider Name (Legal Business Name): VANESSA MARTINEZ FNP. PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 E BAYOU RD
THIBODAUX LA
70301-8036
US

IV. Provider business mailing address

312 E BAYOU RD
THIBODAUX LA
70301-8036
US

V. Phone/Fax

Practice location:
  • Phone: 985-266-0444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95023487
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number234436
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95023487
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number234436
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: