Individual
MISS EMILY RENEE THIBODAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
1103 KALISTE SALOOM RD, SUITE 206, LAFAYETTE, LA 70508-5783
(337) 267-1319
(337) 267-1379
Mailing address
1018 HIGHWAY 304, THIBODAUX, LA 70301-7331
(985) 414-0724
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
200652
—
Other
Enumeration date
09/23/2013
Last updated
09/23/2013
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