Provider Demographics
NPI:1245666254
Name:THIBODAUX, EMILY RENEE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:EMILY
Middle Name:RENEE
Last Name:THIBODAUX
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1018 HIGHWAY 304
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-7331
Mailing Address - Country:US
Mailing Address - Phone:985-414-0724
Mailing Address - Fax:
Practice Address - Street 1:1103 KALISTE SALOOM RD
Practice Address - Street 2:SUITE 206
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5783
Practice Address - Country:US
Practice Address - Phone:337-267-1319
Practice Address - Fax:337-267-1379
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
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Provider Licenses
StateLicense IDTaxonomies
200652363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical