Matthew Blaine Theriot, N.P.

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

AP04908 Issued in LA

Practice address

2362 Larkspur LN
Opelousas, LA 70570-8674

Phone

(337) 594-0675

Fax

(337) 594-0850

NPI assigned

May 25, 2006

Last updated

Apr 6, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Louisiana Cardiovascular and Limb Salvage Center, Apmc

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Lafayette, LA
  • NPI 1689825499
  NPD (past)

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617667200000",
    "number": "1346296027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2362 LARKSPUR LN",
            "city": "OPELOUSAS",
            "state": "LA",
            "postal_code": "705708674",
            "telephone_number": "337-594-0675",
            "fax_number": "337-594-0850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2362 LARKSPUR LN",
            "city": "OPELOUSAS",
            "state": "LA",
            "postal_code": "705708674",
            "telephone_number": "337-594-0675",
            "fax_number": "337-594-0850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THERIOT",
        "first_name": "MATTHEW",
        "middle_name": "BLAINE",
        "name_prefix": "Mr.",
        "credential": "N.P.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2021-04-06",
        "certification_date": "2021-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "LA",
            "license": "AP04908",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "LA",
            "license": "AP04908",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1527408",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "matthew.theriot.1@18070.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "2362 Larkspur Ln",
            "city": "Opelousas",
            "state": "LA",
            "country_code": "US",
            "postal_code": "705708674",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Rachel Taylor, APRN-BC
• Taran Taylor, PA-C
• Gervis Tezeno Jr.
• Jalencia Tezeno
• The Family Clinic Inc
• Randy Thibodeaix
• Angela Mae Thibodeaux-Goins, C-FNP
• Amber Thibodeaux
• Ambrose Carroll Thibodeaux Jr., MT
• Carole Ann Thibodeaux, LAC AND RN

• Nurse Practitioner in Opelousas, LA
• Providers in Opelousas, LA by specialty
• Nurse Practitioner in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.