Individual
DERRICK THIBODEAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
N.P.
Contact information
Practice address
1303 HORRIDGE ST, VINTON, LA 70668-4531
(337) 324-8060
(337) 324-8061
Mailing address
1303 HORRIDGE ST, VINTON, LA 70668-4531
(337) 324-8060
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP08118
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AP08118
LOUISIANA STATE BOARD OF NURSING
LA
Enumeration date
02/10/2015
Last updated
03/09/2026
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