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General NPI Number Information
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NPI Number | 1306187778
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Entity Type | Individual
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Provider Name | CRYSTAL THIBODEAUX FNP-C
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Gender | Female
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Dates
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Enumeration Date | 03/11/2013
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Last Update Date | 07/13/2016
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Provider Practice Location Address
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Address Line | 1570 LINDBERG DR STE 8
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City | SLIDELL
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State | LA
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Zip | 70458-8084
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Country | US
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Telephone | 985-205-3456
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Fax | 985-288-0047
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Provider Business Mailing Address
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Address Line | 1575 HERITAGE DR STE 205
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City | MCKINNEY
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State | TX
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Zip | 75069-3386
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Country | US
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Telephone | 225-276-7201
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Fax |
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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 | AP06836
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License Number State | LA
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