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Individual
TERRY LEE BROADBENT
Active
Individual
TERRY LEE BROADBENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ARNP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
13-69014-121
KS
363L00000X
Nurse Practitioner
Primary
45612
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13-69014-121
RN LICENSE
KS
01
—
45612
ARNP LICENSE
KS
Enumeration date
06/15/2007
Last updated
07/08/2007
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