Colby Ryan Thibodeaux, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

211814 Issued in LA

Practice address

4345 Nelson Rd Ste 101
Lake Charles, LA 70605-4183

Phone

(337) 480-7942

Fax

(337) 480-7964

NPI assigned

Feb 6, 2020

Last updated

Apr 28, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/23344/brand/1/csg/1/fhir/r4

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.

• Calcasieu Urgent Care LLC

  dba Calcasieu Urgent Care

  • Urgent Care Clinic/Center
  • Lake Charles, LA
  • NPI 1467715490
  Medicare reassignment NPD
• Upperline Healthcare, PC

  • Foot & Ankle Surgery Podiatrist
  • Hoover, AL
  • NPI 1538686498

  LA

  Medicare reassignment NPD
• Calcasieu Urgent Care, LLC

  • Rural Health Clinic/Center
  • Breaux Bridge, LA
  • NPI 1194482398
  NPD
• Upperline Healthcare, PC

  • Foot & Ankle Surgery Podiatrist
  • Ocoee, FL
  • NPI 1326906843
  NPD
• MMG Nelson Rd LLC

  • General Practice Physician
  • Lake Charles, LA
  • NPI 1295103844
  NPD (past)
• Swlhs LLC

  dba Internal Medicine Clinic of Lake Charles

  • Internal Medicine Physician
  • Lake Charles, LA
  • NPI 1669494654
  NPD (past)
• Jasper County Urgent Care PLLC

  • Urgent Care Clinic/Center
  • Jasper, TX
  • NPI 1972038503
  NPD (past)

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

{
    "created_epoch": "1580947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651104000000",
    "number": "1912539115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 122165 DEPT 2165",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753122162",
            "telephone_number": "337-494-2921",
            "fax_number": "337-494-6523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4345 NELSON RD STE 101",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706054183",
            "telephone_number": "337-480-7942",
            "fax_number": "337-480-7964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIBODEAUX",
        "first_name": "COLBY",
        "middle_name": "RYAN",
        "name_prefix": "Mr.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-06",
        "last_updated": "2022-04-28",
        "certification_date": "2022-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "211814",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2571796",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacob M Theriot, FNP-C
• Kelli Theriot, DPT
• Michael Todd Theriot, D.C.
• Travis Edward Theriot, MS, LAT, ATC
• Kirk James Thibeaux, MBA
• Elise Thibodeaux
• Emily Granger Thibodeaux, FNP
• James Thibodeaux, PHARMD.
• Joel D Thibodeaux, M.D.
• Kourtney Thibodeaux, PSS

• Family Nurse Practitioner in Lake Charles, LA
• Providers in Lake Charles, LA by specialty
• Family Nurse Practitioner in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2022; 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.