Individual
MS. ROMONA BROUSSARD MAYEUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
248 E CAPITOL ST, ROOM 105, JACKSON, MS 39201-2503
(601) 714-2563
(601) 510-4653
Mailing address
248 E CAPITOL ST, ROOM 105, JACKSON, MS 39201-2503
(601) 714-2563
(601) 510-4653
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R881289
MS
363LF0000X
Family Nurse Practitioner
RN041380 AP01824
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1655244
—
LA
01
—
AP01824
APN LICENSE NUMBER
LA
01
—
R881289
MISSISSIPPI STATES BOARD OF NURSING
MS
01
—
RN041380
RN LICENSE NUMBER
LA
Enumeration date
06/01/2005
Last updated
01/13/2015
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