Organization
THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION
Active
Other names
Thibodaux Regional Neurology Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KIM LEGENDRE BOUDREAUX (CONTRACT MANAGER)
(985) 493-4907
Entity
Organization
Contact information
Practice address
726 N. ACADIA RD, STE 2300, THIBODAUX, LA 70301-5078
(985) 493-3090
(985) 493-3091
Mailing address
602 N ACADIA RD, THIBODAUX, LA 70301-4823
(985) 493-3090
(985) 493-3091
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2376365
—
LA
Enumeration date
05/27/2014
Last updated
06/02/2025
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