NPIMap

Individual provider Active NPI

Derrick Thibodeaux, N.P.

  • Family Nurse Practitioner
  • Vinton, LA
National Provider Identifier
1659762839
Registry record updated Mar 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP08118 Issued in LA
Practice address
1303 Horridge St
Vinton, LA 70668-4531
Phone
(337) 324-8060
Fax
(337) 324-8061
NPI assigned
Feb 10, 2015
Last updated
Mar 9, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP08118 LA Primary

Addresses

Primary practice location

1303 Horridge St
Vinton, LA 70668-4531

Mailing address

1303 Horridge St
Vinton, LA 70668-4531
Phone (337) 324-8060

Other practice location 1

810 E Fourth St
Dequincy, LA 70633-3708
Phone (337) 265-1180

Other identifiers 1

IdentifierTypeStateIssuer
AP08118OtherLALOUISIANA STATE BOARD OF NURSING

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160105001532 LA Practitioner - Nurse Practitioner 4385946565 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Thibodeaux Medical Clinic, LLCGroup PAC ID 2365774189, 3 clinicians

Practice addresses (Care Compare)

1311 Horridge St
Vinton, LA 70668-4531
Phone (337) 739-3134

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP08118LAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Calcasieu Urgent Care, LLC CurrentSince Oct 1, 2017 Accepting new patients
Kisatchie Emergency Group, LLC Nurse Practitioner CurrentSince Apr 6, 2019 Accepting new patients
Sound Physicians Emergency Medicine of Louisiana Inc CurrentSince Sep 17, 2019 Accepting new patients
Thibodeaux Enterprises of Texas CurrentSince Dec 22, 2022 Accepting new patients
Calcasieu Urgent Care LLC CurrentSince Oct 1, 2017 Accepting new patients
Thibodeaux Medical Clinic of Dequincy CurrentSince Jun 1, 2026 Accepting new patients
Thibodeaux Medical Clinic, LLC CurrentSince Nov 1, 2019 Accepting new patients
GPN-Leesville, LLC Past Accepting new patients
South Beauregard Health Center, L.L.C. PastSince Jul 19, 2018 Accepting new patients

Locations

810 E Fourth St
Dequincy, LA 70633
Phone (337) 265-1180

2640 Country Club Rd
Ste 400
Lake Charles, LA 70605
Phone (337) 426-0919

4200 Nelson Rd
Lake Charles, LA 70605
Phone (318) 474-6370

524 Dr Michael Debakey Dr
Lake Charles, LA 70601
Phone (337) 430-4455

1020 W Fertitta Blvd
Leesville, LA 71446
Phone (337) 239-5278

242 Sam Houston Jones Pkwy
Moss Bluff, LA 70611
Phone (337) 905-4000

1303 Horridge St
Vinton, LA 70668
Phone (337) 324-8060

1311 Horridge St
Vinton, LA 70668
Phone (337) 324-8060

Organizations & group practices 9

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.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1423526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773014400000",
    "number": "1659762839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1303 HORRIDGE ST",
            "city": "VINTON",
            "state": "LA",
            "postal_code": "706684531",
            "telephone_number": "337-324-8060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1303 HORRIDGE ST",
            "city": "VINTON",
            "state": "LA",
            "postal_code": "706684531",
            "telephone_number": "337-324-8060",
            "fax_number": "337-324-8061"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "810 E Fourth St",
            "address_purpose": "LOCATION",
            "city": "Dequincy",
            "state": "LA",
            "postal_code": "706333708",
            "country_code": "US",
            "telephone_number": "337-265-1180",
            "fax_number": "337-265-1181",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THIBODEAUX",
        "first_name": "DERRICK",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-02-10",
        "last_updated": "2026-03-09",
        "certification_date": "2026-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "AP08118",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LOUISIANA STATE BOARD OF NURSING",
            "identifier": "AP08118",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vinton, LA

Sources for this page

Verify at the official NPI Registry.