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Individual

STEFANIE HUMMEL THERIOT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
105 PATRIOT ST STE 101, LAFAYETTE, LA 70508-6831
(337) 981-2125
(337) 981-2174
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(800) 893-9698

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
308907
LA
363AS0400X
Surgical Physician Assistant
PA.308907
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2503596
LA
Enumeration date
08/02/2018
Last updated
08/24/2021
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