KELLY THIBODEAUX (NPI# 1639552979) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639552979 |
| Entity Type | Individual |
| Full Name | KELLY THIBODEAUX |
| Credential | NP |
| Practice Address |
1111 Medical Center Blvd 350s Marrero LA 70072-3151 |
| Practice Telephone | 5043496350 |
| Mailing Telephone | 5043496350 |
| Enumeration Date | 2015-07-06 |
| Last Update Date | 2015-07-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
AP08412 | LA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | LICENSE | AP08412 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902388291 | Kelly Cates Thibodeaux | Licensed Vocational Nurse | 20503 Newfalls Ct, Richmond, TX 77407-7856 | 2018-09-03 |
| 1912485111 | Kelly Thibodeaux | Case Manager/Care Coordinator | 120 Huggins Rd, Lafayette, LA 70506-5802 | 2018-07-31 |
| Street Address |
1111 MEDICAL CENTER BLVD 350S |
| City | MARRERO |
| State | LA |
| Zip Code | 70072-3151 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487657359 | West Jefferson Surgery Center, LLC | Clinic/Center | 1111 Medical Center Blvd, Ste 105n, Marrero, LA 70072-3152 | 2005-05-24 |
| 1972129211 | Marissa Liantonio Miller | Nurse Practitioner | 1111 Medical Center Blvd, Marrero, LA 70072-3151 | 2020-06-23 |
| 1952920324 | Kirstie Rae Schieffler | Physician Assistant | 1111 Medical Center Blvd, Marrero, LA 70072-3151 | 2020-04-15 |
| 1841730918 | Samantha Schenker | Nurse Practitioner | 1111 Medical Center Blvd, N406, Marrero, LA 70072-3151 | 2017-03-08 |
| 1376092379 | Shelli Rodriguez Ergen | Nurse Practitioner | 1111 Medical Center Blvd, Suite South 113, Marrero, LA 70072-3151 | 2016-10-02 |
| 1326418443 | Cain Foot Center, LLC | Podiatrist | 1111 Medical Center Blvd, Suite N-313, Marrero, LA 70072-3151 | 2015-10-01 |
| 1235515693 | Joseph Guarnieri | Eyewear Supplier (Equipment, not the service) | 1111 Medical Center Blvd, Suite N-114, Marrero, LA 70072-3151 | 2015-08-07 |
| 1629478409 | Ochsner Clinic LLC | General Practice | 1111 Medical Center Blvd, Suite 313n, Marrero, LA 70072-3151 | 2014-08-28 |
| 1285034553 | Raven S Jackson | Pharmacist | 1111 Medical Center Blvd, S 850, Marrero, LA 70072-3151 | 2014-08-24 |
| 1457767717 | Elisabeth Lifsey-wood | Nurse Anesthetist, Certified Registered | 1111 Medical Center Blvd, Marrero, LA 70072-3151 | 2014-07-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780232579 | Brittany Inez Young | Technician | 4465 Bay View Drive, Marrero, LA 70072 | 2019-08-27 |
| 1356829774 | Zachary Allen Runge Kleinpeter | Physician Assistant | 1111 Medical Center Blvd Ste S630, Marrero, LA 70072 | 2018-07-30 |
| 1689172611 | Derron White | Specialist | 2324 Barataria Blvd, Marrero, LA 70072 | 2018-01-24 |
| 1477064616 | Bone & Joint, LLC Physical Therapy | Physical Therapist | 4633 Wichers Dr., Marrero, LA 70072 | 2017-10-16 |
| 1477077410 | Darlene Jenkins | Case Manager/Care Coordinator | 7606 Westbank Expy Ste B, Marrero, LA 70072 | 2017-08-01 |
| 1871017186 | Tyra K Haynes | Non-emergency Medical Transport (VAN) | 536 Westwood Drive, Marrero, LA 70072 | 2017-07-28 |
| 1265961536 | Danika Kayelle Frank | Social Worker | 6189 Boutte St, Marrero, LA 70072 | 2017-06-08 |
| 1528596673 | Monica Cheree Mayberry | Counselor | 931 Westwood Dr., Marrero, LA 70072 | 2017-06-01 |
| 1710419197 | Sharla Black | Counselor | 2069 Paine Drive, Marrero, LA 70072 | 2017-04-03 |
| 1699207043 | Tango Austin | Counselor | 2573 Foliage Drive, Marrero, LA 70072 | 2017-04-03 |
| Find all providers in zip 70072 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316568686 | Carlita Durall | Nurse Practitioner | 1624 Farrington Dr, Marrero, LA 70072-4018 | 2020-04-28 |
| 1225558976 | Courtney R Clement | Nurse Practitioner | 1111 Medical Center Blvd Ste 350, Marrero, LA 70072-3186 | 2017-06-23 |
| 1013469022 | Nadinna Joseph | Nurse Practitioner | 534 Avenue C, Marrero, LA 70072-2022 | 2016-10-26 |
| 1629441282 | Callie Estes Rothwell | Nurse Practitioner | 1111 Medical Center Blvd Ste N406, Marrero, LA 70072-3155 | 2015-11-04 |
| 1407240310 | Johnether Smith | Nurse Practitioner | 1080 Artesa Dr, Marrero, LA 70072-5967 | 2015-03-28 |
| 1730578881 | Danielle Rae Alfortish | Nurse Practitioner | 1111 Medical Center Blvd Ste S-750, Marrero, LA 70072-3151 | 2015-01-13 |
| 1003155227 | Hilary Gary Fincke | Nurse Practitioner | 1111 Medical Center Blvd Ste N804, Marrero, LA 70072-3173 | 2013-02-07 |
| 1710146196 | Maria-azucena Mercado Ramos | Nurse Practitioner | 1111 Medical Center Blvd Ste S113, Marrero, LA 70072-3151 | 2008-06-02 |
| 1174526644 | Ana Maria H. Hebert | Nurse Practitioner | 1111 Medical Center Blvd N713, Marrero, LA 70072 | 2005-05-27 |
| 1497369052 | Tyra Branch | Nurse Practitioner | 1101 Medical Center Blvd, Marrero, LA 70072-3147 | 2020-09-01 |
| Find all providers in MARRERO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.