Individual
MR. COLBY RYAN THIBODEAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
4345 NELSON RD STE 101, LAKE CHARLES, LA 70605-4183
(337) 480-7942
(337) 480-7964
Mailing address
PO BOX 122165 DEPT 2165, DALLAS, TX 75312-2162
(337) 494-2921
(337) 494-6523
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
211814
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2571796
—
LA
Enumeration date
02/06/2020
Last updated
04/28/2022
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