Provider Demographics
NPI:1609396050
Name:ROMERO, ASHLEY THIBODEAUX (PA)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:THIBODEAUX
Last Name:ROMERO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 BRAQUET RD
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-5144
Mailing Address - Country:US
Mailing Address - Phone:337-230-5119
Mailing Address - Fax:
Practice Address - Street 1:99 W MARTIAL AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6583
Practice Address - Country:US
Practice Address - Phone:337-234-5344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA305568363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant