Healthcare Provider Details

I. General information

NPI: 1831003052
Provider Name (Legal Business Name): DR. NIA ALEXANDRA BROUSSARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 PRUDHOMME CIR
OPELOUSAS LA
70570-6544
US

IV. Provider business mailing address

1119 PRUDHOMME CIR
OPELOUSAS LA
70570-6516
US

V. Phone/Fax

Practice location:
  • Phone: 133-744-7402
  • Fax:
Mailing address:
  • Phone: 133-744-7402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number211206
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: