Provider Demographics
NPI:1730431297
Name:THERIOT, REBECCA B (APN)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:B
Last Name:THERIOT
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1002
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-1002
Mailing Address - Country:US
Mailing Address - Phone:337-788-0177
Mailing Address - Fax:337-232-3656
Practice Address - Street 1:800 KALISTE SALOOM RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-4210
Practice Address - Country:US
Practice Address - Phone:337-233-2400
Practice Address - Fax:337-232-3656
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07092363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health