Individual
KELLY THIBODEAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2600 BELLE CHASSE HWY # B2, TERRYTOWN, LA 70056-7156
(504) 349-2273
Mailing address
2600 BELLE CHASSE HWY # B2, TERRYTOWN, LA 70056-7156
(504) 349-2273
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP08412
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AP08412
LICENSE
LA
Enumeration date
07/06/2015
Last updated
09/05/2025
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