Individual
KIMBERLY MARIE BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
249 CORPORATE DR, HOUMA, LA 70360-2769
(985) 853-0900
Mailing address
249 CORPORATE DR, HOUMA, LA 70360-2769
(985) 853-0900
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.200597
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01253212
—
MS
05
—
2330438
—
LA
Enumeration date
04/22/2013
Last updated
07/20/2023
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