Individual
MRS. JAMILIA LASHAWN BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN RN FNP-BC WCC
Contact information
Practice address
1001 12TH AVE NW, ARDMORE, OK 73401-5712
(580) 220-6290
(580) 220-6215
Mailing address
PO BOX 678219, DALLAS, TX 75267-8219
(214) 970-6817
(844) 803-4513
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
821209
TX
363LF0000X
Family Nurse Practitioner
Primary
AP136689
TX
Other
Enumeration date
01/24/2018
Last updated
08/03/2021
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