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Individual
LARA CORNELIA THIBODEAUX
Active
Individual
LARA CORNELIA THIBODEAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
593517
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1841562451
FACILITY NPI (SJHP FRANKLIN)
TX
01
—
2952517-01
BVCAA DBA ST,. JOSEPH HEALTH POINT FRANKLIN MEDICAID (PTAN) NUMBER
TX
01
—
67-1981
BVCAA DBA: ST. JOSEPH HEALTH POINT FRANKLIN PTAN (MEDICARE NUMBER)
TX
Enumeration date
10/08/2005
Last updated
02/13/2019
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