Provider Demographics
NPI:1992092019
Name:THIBODEAUX, KYLIE YOUNG (WHNP-BC)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:YOUNG
Last Name:THIBODEAUX
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 PRUDHOMME CIR
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6516
Mailing Address - Country:US
Mailing Address - Phone:337-447-4027
Mailing Address - Fax:877-449-6518
Practice Address - Street 1:1119 PRUDHOMME CIR
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6516
Practice Address - Country:US
Practice Address - Phone:337-447-4027
Practice Address - Fax:877-449-6518
Is Sole Proprietor?:No
Enumeration Date:2011-07-10
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06541363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health