Individual
MS. LUCY BROADDUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MMS, PA-C, ATC.
Contact information
Practice address
310 N 7 HILLS RD STE 220, O FALLON, IL 62269-4111
(618) 624-6181
Mailing address
310 N 7 HILLS RD STE 220, O FALLON, IL 62269-4111
(618) 624-6181
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085004281
IL
Other
Enumeration date
02/01/2012
Last updated
01/26/2026
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