Healthcare Provider Details

I. General information

NPI: 1598606493
Provider Name (Legal Business Name): JEFFREY KEITH BROADBENT MS, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4980 W SAHARA AVE STE 260
LAS VEGAS NV
89146-3435
US

IV. Provider business mailing address

4980 W SAHARA AVE STE 260
LAS VEGAS NV
89146-3435
US

V. Phone/Fax

Practice location:
  • Phone: 385-392-5985
  • Fax:
Mailing address:
  • Phone: 385-392-5985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT0506858
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number2026002984
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: