Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Champ Phuphanich, FNP

Individual provider Family Nurse Practitioner · NPI 1023765427

Champ Phuphanich, FNP is a Nurse Practitioner in Thibodaux, Louisiana. Qualified in 2021, 5 years ago. Practices with St Mary Emergency Group LLC, a 16-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Louisiana.

Years since qualifying
5
Licensed in
LA
In the registry since
2022
What do these letters mean?
FNP — Family Nurse Practitioner
A nurse practitioner who treats patients of all ages, much like a family doctor.

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Practice location Address checks out

305 E 1st St
Thibodaux, LA 70301-3341
Phone: (985) 228-6028
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1990 Industrial Blvd, Houma, LA 70363-7055 — (985) 868-9300

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 224407 (LA)

Record details

NPI number1023765427
Entity typeIndividual (Type 1)
GenderMale
Credentials FNP
Sole proprietorNo
NPI enumeratedMarch 4, 2022
Last updated in NPPESApril 16, 2024
Certification dateMarch 6, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice St Mary Emergency Group Llc — 16 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Thibodaux