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NPI Code Detail

MEDICARE: MS. IVEY BROXTON NP

MEDICARE: MS. IVEY BROXTON NP
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
1363L00000XNurse PractitionerAPRN-NP165181GA

Other Identifiers

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

General Provider Information

NPI Number : 1073700886
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. IVEY BROXTON NP
Provider Business Mailing Address
First Line : 1150 GOLDEN WAY
Second Line :
City : WATKINSVILLE
State : GA
Zip : 30677-7712
Country : US
Telephone Number : 706-612-9401
Fax Number : 706-612-9420
Provider Business Practice Location Address
First Line : 1150 GOLDEN WAY
Second Line :
City : WATKINSVILLE
State : GA
Zip : 30677-7712
Country : US
Telephone Number : 706-612-9401
Fax Number : 706-612-9420
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2007
Last Update Date : 10/28/2025

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