Healthcare Provider Details

I. General information

NPI: 1528985819
Provider Name (Legal Business Name): BENJAMIN JOSEPH RIVIERE APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 N ACADIA RD
THIBODAUX LA
70301-4847
US

IV. Provider business mailing address

602 N ACADIA RD
THIBODAUX LA
70301-4847
US

V. Phone/Fax

Practice location:
  • Phone: 985-447-5500
  • Fax: 985-493-4491
Mailing address:
  • Phone: 985-447-5500
  • Fax: 985-493-4491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number247601
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: