Nicholas John Thibault, PA-C is a
Physician Assistant - Medical based in Midway Park, North Carolina. Nicholas John Thibault is licensed to practice in California (license number ) and his current practice location is
1003 Churchill Way Apt 2e, Midway Park, North Carolina. He can be reached at his office (for appointments etc.) via phone at
(219) 689-8493.
NPI number for Nicholas John Thibault is 1043612070 and his current mailing address is 1900 Gator Blvd, Building 3808, Virginia Beach, Virginia. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1043612070.
Provider's Profile
Full Name | Nicholas John Thibault |
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Gender | Male |
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Speciality | Physician Assistant - Medical |
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Location | 1003 Churchill Way Apt 2e, Midway Park, North Carolina |
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Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
NPI Data:
- NPI Number: 1043612070
- Provider Enumeration Date: 09/22/2014
- Last Update Date: 01/25/2021
Medical Identifiers
Medical identifiers for Nicholas John Thibault such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1043612070 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
363AM0700X | Physician Assistant - Medical | (California) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Nicholas John Thibault is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Nicholas John Thibault, PA-C 1900 Gator Blvd, Building 3808, Virginia Beach, VA 23459-8950 Ph: (757) 763-3619 | Nicholas John Thibault, PA-C 1003 Churchill Way Apt 2e, Midway Park, NC 28544-1285 Ph: (219) 689-8493 |
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