# THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Thibodaux Regional Family Medicine Clinic - Pierre Part
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790561868
- **Authorized official:** KIM LEGENDRE BOUDREAUX (DIRECTOR OF CONTRACTING)
- **Authorized official phone:** (985) 493-4907

## Contact information

- **Practice address:** 3928 HIGHWAY 70 S, PIERRE PART, LA 70339-4460
- **Practice address phone:** (985) 369-6070
- **Practice address fax:** (985) 252-1400
- **Mailing address:** 602 NORTH ACADIA ROAD, CONTRACT MANAGEMENT DEPT., THIBODAUX, LA 70301
- **Mailing address phone:** (985) 493-4907

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 09/05/2023
- **Last updated:** 06/03/2025