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General NPI Number Information
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NPI Number | 1710320908
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Entity Type | Organization
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Legal Business Name | BROUSSARD FAMILY PRACTICE, PLLC
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Dates
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Enumeration Date | 04/08/2013
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 810 HOSPITAL DR STE 100
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City | BEAUMONT
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State | TX
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Zip | 77701-4633
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Country | US
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Telephone | 409-833-0342
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7096
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City | BEAUMONT
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State | TX
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Zip | 77726-7096
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Country | US
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Telephone | 409-833-0342
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Fax | 877-770-4091
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER/OWNER
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Name | MRS. JULIETTE ROSE BROUSSARD
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Credential | FNPC
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Telephone | 409-833-0342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 651610
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | L2891
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License Number State | TX
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