Provider Demographics
NPI:1033890611
Name:BREAUX, KARLIE TROSCLAIR (PA-C)
Entity type:Individual
Prefix:
First Name:KARLIE
Middle Name:TROSCLAIR
Last Name:BREAUX
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-8022
Mailing Address - Country:US
Mailing Address - Phone:985-414-0775
Mailing Address - Fax:
Practice Address - Street 1:4308 ALLENBROOK DR
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3200
Practice Address - Country:US
Practice Address - Phone:281-422-4141
Practice Address - Fax:281-422-5939
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA18128363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical