MEDICARE: AIMEE C BROUSSARD APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN094687-AP06057	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710209044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AIMEE C BROUSSARD APRN

Provider Business Mailing Address
First Line	:	P O BOX 1317
Second Line	:
City	:	BROUSSARD
State	:	LA
Zip	:	70518-1317
Country	:	US
Telephone Number	:	337-330-4730
Fax Number	:	337-330-4732

Provider Business Practice Location Address
First Line	:	805 ALBERTSON PKWY STE A
Second Line	:
City	:	BROUSSARD
State	:	LA
Zip	:	70518-4350
Country	:	US
Telephone Number	:	337-330-4730
Fax Number	:	337-330-4732

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2010
Last Update Date	:	01/28/2016

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Directions to “ AIMEE C BROUSSARD APRN” Practice Location

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