Provider Demographics
NPI:1376250332
Name:THIBODEAUX-FOSTER, NAKIA
Entity Type:Individual
Prefix:
First Name:NAKIA
Middle Name:
Last Name:THIBODEAUX-FOSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 S GESSNER RD STE 208
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-3774
Mailing Address - Country:US
Mailing Address - Phone:832-832-1825
Mailing Address - Fax:
Practice Address - Street 1:2950 GESSNER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080-2506
Practice Address - Country:US
Practice Address - Phone:832-699-6932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty