Organization
THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION
Active
Other names
Thibodaux Regional Pediatric Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KIM LEGENDRE BOUDREAUX (CONTRACT MANAGER)
(985) 493-4907
Entity
Organization
Contact information
Practice address
604 N ACADIA RD STE 100, THIBODAUX, LA 70301-4897
(985) 447-9045
Mailing address
PO BOX 5478, THIBODAUX, LA 70302-5478
(985) 435-4831
(985) 449-2513
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207QA0000X
Adolescent Medicine (Family Medicine) Physician
—
—
208000000X
Pediatrics Physician
Primary
—
—
2080A0000X
Pediatric Adolescent Medicine Physician
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
Other
Enumeration date
11/23/2020
Last updated
03/06/2025
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