# THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Thibodaux Regional Wellness Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316604762
- **Authorized official:** KIM LEGENDRE BOUDREAUX (CONTRACT MANAGER)
- **Authorized official phone:** (985) 493-4907

## Contact information

- **Practice address:** 726 N. ACADIA ROAD, EDUCATION SUITE, THIBODAUX, LA 70301
- **Practice address phone:** (985) 493-4004
- **Mailing address:** 602 N ACADIA RD, THIBODAUX, LA 70301-4823
- **Mailing address phone:** (985) 493-4907
- **Mailing address fax:** (985) 449-2585

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/19/2021
- **Last updated:** 09/05/2023