Individual
JOHN DAVID THERIOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
225 DUNN ST, HOUMA, LA 70360-4413
(985) 876-0300
(985) 872-0317
Mailing address
PO BOX 4176, HOUMA, LA 70361-4176
(985) 876-0300
(985) 872-0317
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN065771 - AP03378
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1554090
—
LA
01
—
500007519
RR MEDICARE
LA
Enumeration date
07/07/2005
Last updated
10/20/2015
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