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General NPI Number Information
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NPI Number | 1104028554
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Entity Type | Individual
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Provider Name | HOLLY THIBODEAUX FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 24727 TOMBALL PARKWAY SUITE 120
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City | TOMBALL
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State | TX
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Zip | 77375
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Country | US
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Telephone | 281-440-5300
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Fax | 281-378-3850
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Provider Business Mailing Address
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Address Line | 506 GRAHAM DR STE 200
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City | TOMBALL
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State | TX
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Zip | 77375-3346
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Country | US
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Telephone | 281-255-3838
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Fax | 281-255-3788
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 125933
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License Number State | TX
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