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General NPI Number Information
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NPI Number | 1861718926
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Entity Type | Individual
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Provider Name | JESSICA BENOIT THIBODAUX FNP
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Gender | Female
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Dates
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Enumeration Date | 04/14/2010
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Last Update Date | 12/07/2011
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Provider Practice Location Address
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Address Line | 1320 MARTIN LUTHER KING DR
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City | THIBODAUX
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State | LA
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Zip | 70301-4886
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Country | US
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Telephone | 985-446-2021
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Fax | 985-447-1546
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Provider Business Mailing Address
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Address Line | PO BOX 4176
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City | HOUMA
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State | LA
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Zip | 70361-4176
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Country | US
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Telephone | 985-876-0300
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Fax | 985-872-0317
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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 | AP06094
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License Number State | LA
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