Organization
THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION
Active
Other names
Thibodaux Regional Work Site Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
KIM LEGENDRE BOUDREAUX (CONTRACT MANAGER)
(985) 493-4907
Entity
Organization
Contact information
Practice address
400 N ACADIA RD, THIBODAUX, LA 70301-4856
(985) 493-4004
Mailing address
602 N ACADIA RD, THIBODAUX, LA 70301-4823
(985) 493-4740
(985) 449-2585
Taxonomy
Speciality
Code
Description
License number
State
136A00000X
Registered Dietetic Technician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
11/29/2021
Last updated
05/09/2024
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