Individual
MRS. MEREDITH WADE THIBODEAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
1541 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 675-4394
(318) 675-6186
Mailing address
479 HOLOMON LOOP, DUBBERLY, LA 71024-2747
(318) 564-8781
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
200668
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2345290
—
LA
Enumeration date
09/11/2013
Last updated
12/10/2015
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