Provider Demographics
NPI:1285207860
Name:THIBODAUX, LAURA PATRICIA (FNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:PATRICIA
Last Name:THIBODAUX
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 N 11TH ST STE P2200
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1513
Mailing Address - Country:US
Mailing Address - Phone:409-892-1192
Mailing Address - Fax:409-899-4956
Practice Address - Street 1:755 N 11TH ST STE P2200
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1513
Practice Address - Country:US
Practice Address - Phone:409-892-1192
Practice Address - Fax:409-899-4956
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1048025363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily