Emily Renee Thibodaux, P.A.-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

200652 Issued in NU

Practice address

1103 Kaliste Saloom Rd
Suite 206
Lafayette, LA 70508-5783

Phone

(337) 267-1319

Fax

(337) 267-1379

NPI assigned

Sep 23, 2013

Last updated

Sep 23, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1379894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379894400000",
    "number": "1245666254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1018 HIGHWAY 304",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703017331",
            "telephone_number": "985-414-0724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 KALISTE SALOOM RD",
            "address_2": "SUITE 206",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705085783",
            "telephone_number": "337-267-1319",
            "fax_number": "337-267-1379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIBODAUX",
        "first_name": "EMILY",
        "middle_name": "RENEE",
        "name_prefix": "Miss",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-23",
        "last_updated": "2013-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NU",
            "license": "200652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stefanie Hummel Theriot, PA-C
• Andrew Thevis
• Jade Thibeaux
• Ruth Ann Thibeaux, M.S., CCC-SLP
• Whitley M Thibeaux
• Amanda Clare Thibodeaux
• Amber Thibodeaux
• Anthony Collins Thibodeaux, M.D.
• Brett Michael Thibodeaux, M.S., PLPC
• Brittin Thibodeaux, MD

• Surgical Physician Assistant in Lafayette, LA
• Providers in Lafayette, LA by specialty
• Surgical Physician Assistant in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.