Individual
DR. LENITA THIBAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
135 W RAVINE RD, SUITE 1A, KINGSPORT, TN 37660-3847
(423) 224-4920
(423) 224-4929
Mailing address
999 EXECUTIVE PARK BLVD, SUITE 201, KINGSPORT, TN 37660-4632
(423) 224-3250
(423) 224-3258
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
21333
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010169836
—
VA
Enumeration date
07/20/2006
Last updated
07/12/2012
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