Individual
JACOB M THERIOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
4345 NELSON RD STE 101, LAKE CHARLES, LA 70605-4183
(337) 480-7942
(337) 480-7964
Mailing address
PO BOX 122165 DEPT 2165, DALLAS, TX 75312-2165
(337) 494-2921
(337) 494-6523
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
210780
LA
363LF0000X
Family Nurse Practitioner
Primary
210780
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
210780
CERTIFIED NURSE PRACTITIONER
LA
05
—
3449382
—
LA
01
—
RN138165
RN
LA
Enumeration date
08/13/2020
Last updated
09/26/2022
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