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Individual

JESSIRAE BROUSSARD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
AA

Contact information

Practice address
2525 GLENN HENDREN DR, ANESTHESIA DEPT, LIBERTY, MO 64068-9625
(816) 781-7200
(816) 792-7196
Mailing address
PO BOX 804408, KANSAS CITY, MO 64180-4408
(913) 647-4100
(913) 647-4120

Taxonomy

Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
2014018078
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1326452962
MO
01
50498011
BCBS KC
MO
01
P01350390
RAILROAD
MO
Enumeration date
06/11/2014
Last updated
12/09/2020
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