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Individual
KIMBERLY LAUREN BROUSSARD
Active
Individual
KIMBERLY LAUREN BROUSSARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
—
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1709
MEDICAL
—
Enumeration date
06/22/2022
Last updated
09/09/2025
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