Individual
TORIE THIBODEAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030-4000
(713) 792-6161
Mailing address
PO BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
730073
TX
363LA2100X
Acute Care Nurse Practitioner
Primary
AP123786
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
325421103
—
TX
01
—
325421104
CSHCN MEDICAID TPI
TX
05
—
325421104
—
TX
Enumeration date
07/15/2013
Last updated
09/02/2020
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