Provider Demographics
NPI:1306562541
Name:THIBAULT, DAVID (DNP, FNP-BC, PMHS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:THIBAULT
Suffix:
Gender:M
Credentials:DNP, FNP-BC, PMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2779 S 3350 W
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-3540
Mailing Address - Country:US
Mailing Address - Phone:435-772-2633
Mailing Address - Fax:
Practice Address - Street 1:640 E 700 S STE 205A
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-4023
Practice Address - Country:US
Practice Address - Phone:435-772-2633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11146586-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner