Broussard, Andrea

Broussard, Andrea is an individual health care provider with primary practice located at 406 Pass Rd , Gulfport MS 39507. He recently has 4 registered licenses in different health care specialties including Emergency Medical Service Providers / Personal Emergency Response Attendant, Other Service Providers / Driver, Nursing Service Related Providers / Personal Care Attendant, Nursing Service Related Providers / Home Health Aide. Nursing Service Related Providers / Home Health Aide is his primary health care specialty. Broussard, Andrea can be contacted via phone (286) 699-8402.

Contact Information

Primary practice address
406 Pass Rd Gulfport MS 39507
Phone: (286) 699-8402
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Emergency Medical Service Providers / Personal Emergency Response Attendant 146D00000X
Other Service Providers / Driver 172A00000X
Nursing Service Related Providers / Personal Care Attendant 3747P1801X
Nursing Service Related Providers / Home Health Aide 374U00000X Mississippi

Profile Details

NPI number 1538605027
LBN Legal business name Broussard, Andrea
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 9th, 2017
Last updated Feb 1st, 2019 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1538605027 NPPES
Mississippi MEDICAID 104736701

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