Provider Demographics
NPI:1568485837
Name:THERIOT, CORY D (APRN)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:D
Last Name:THERIOT
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 RUE FONTAINE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5742
Mailing Address - Country:US
Mailing Address - Phone:337-269-9777
Mailing Address - Fax:337-269-0244
Practice Address - Street 1:315 RUE LOUIS XIV BLDG B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5734
Practice Address - Country:US
Practice Address - Phone:337-269-9777
Practice Address - Fax:337-269-0244
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAAP04897363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1372986Medicaid
LA1372986Medicaid
Q70470Medicare UPIN