Healthcare Provider Details

I. General information

NPI: 1689509184
Provider Name (Legal Business Name): MADISEN AMATO FALGOUT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 N ACADIA RD
THIBODAUX LA
70301-4862
US

IV. Provider business mailing address

124 POND DR
THIBODAUX LA
70301-8443
US

V. Phone/Fax

Practice location:
  • Phone: 985-447-5667
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number213118
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: