Provider Demographics
NPI:1750351961
Name:THISTLETHWAITE, CHRISTINE C (PA)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:C
Last Name:THISTLETHWAITE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 TWIN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:RACELAND
Mailing Address - State:LA
Mailing Address - Zip Code:70394-2761
Mailing Address - Country:US
Mailing Address - Phone:985-537-2666
Mailing Address - Fax:985-591-1986
Practice Address - Street 1:141 TWIN OAKS DR
Practice Address - Street 2:
Practice Address - City:RACELAND
Practice Address - State:LA
Practice Address - Zip Code:70394-2761
Practice Address - Country:US
Practice Address - Phone:985-537-2666
Practice Address - Fax:985-537-1986
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA10190363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1039641Medicaid
LA1039641Medicaid