Individual
MR. MATTHEW BLAINE THERIOT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
N.P.
Contact information
Practice address
2362 LARKSPUR LN, OPELOUSAS, LA 70570-8674
(337) 594-0675
(337) 594-0850
Mailing address
2362 LARKSPUR LN, OPELOUSAS, LA 70570-8674
(337) 594-0675
(337) 594-0850
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP04908
LA
363LA2100X
Acute Care Nurse Practitioner
AP04908
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1527408
—
LA
Enumeration date
05/25/2006
Last updated
04/06/2021
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